HIV Telehealth Services: Benefits and Best Practices
In 2020, the SARS-CoV-2 or COVID-19 pandemic ("coronavirus") forced a rapid transition to telehealth services to safely continue HIV treatment and care.1 Telehealth visits frequently replaced in-person office visits with clinicians as an effective way to follow up and keep patients engaged in their health care while protecting them from COVID-19 exposure, both in the clinical setting and while traveling to and from clinic visits. Post-pandemic, healthcare systems and practices are likely to continue exploring telehealth opportunities and solutions.
Telehealth services are on the rise
Telehealth encompasses a broad set of tools and platforms that enable connections between healthcare professionals (HCPs) and patients.2 Telehealth connections generally fall into two categories: synchronous audio-video communications in real time and asynchronous communications involving store-and-forward data, which can be collected and interpreted later, and remote patient monitoring via digital health devices and apps. Using these digital tools for patient triage, diagnosis, treatment, and education can complement traditional, in-person visits and may help improve patient outcomes as well as the financial stability of healthcare practices in an evolving healthcare landscape.
Prior to the COVID-19 pandemic, legal restrictions regarding ethical practice, patient data privacy, and lack of insurance coverage restricted the expansion of telehealth services globally.3 Following the pandemic, there have been some changes to laws and regulatory restrictions in countries around the world surrounding the use of telehealth services, and growing enthusiasm and receptiveness for implementing telehealth technology have contributed to its widespread adoption.
In the United States, private insurers as well as federal and state public health programs have expanded coverage and reimbursement for Medicare and Medicaid services using telehealth technology.4 The Department of Health and Human Services (HHS) Office for Civil Rights has also eased HIPAA restrictions during the pandemic to give HCPs more flexibility for conducting virtual visits using popular non-public facing video chat and text-based apps as well as HIPAA-compliant technology.5 Find more information on these topics using the following links.
For Providers: telehealth.hhs.gov
Tips for getting started, preparing patients for virtual visits, billing, legal considerations, and more
CCHP: Telehealth Policy Finder
Search telehealth policies, COVID-19 actions, and pending legislation
CCHP=Center for Connected Health Policy.
The American Medical Association (AMA) and Centers for Disease Control and Prevention (CDC) cite widespread benefits of telehealth services2,6,7:
Decreased risk of infectious disease transmission, such as COVID-19
Increased patient access to improve continuity of care
Conserve limited medical supplies
More focus on patient wellness and chronic disease management due to extended healthcare system and healthcare provider capacity
Potential to save billions of dollars in healthcare expenditures
Benefits of telehealth services for healthcare providers and patients
The use of telehealth has been accelerated by the pandemic following interim guidelines stating virtual visits may replace in-person visits for routine HIV care and adherence counseling (eg, discussing regimen-related barriers and treatment optimization strategies).8-10 Post-pandemic, HIV care via telehealth can continue to provide opportunities for innovative and individualized care.
In addition to reducing the risk of COVID-19 transmission, real-time video and telephone chats can take place wherever patients and clinicians are located.10 Eliminating the need to commute to and from clinic visits, to take time away from work, and to arrange for childcare makes it easier for patients to keep their scheduled appointments and may help reduce patient no-shows.11 The increased privacy afforded by telehealth services may be particularly attractive to patients with concerns about disclosure, stigma, or parental notification (in the case of minors who identify on the LGBTQ+ spectrum).12 Finally, flexible appointment scheduling, extended hours, and shorter wait times may help improve patient satisfaction and retention, allow for increased patient volume, and boost healthcare practice revenue.
In clinical studies, HCPs have cited advantages to using telehealth services, including the tendency for patients to feel more comfortable and relaxed in their homes, the opportunity to see patients in their familiar social environment, and easy access to patients’ medications for the purpose of documenting a current medication list.1
Regularly attending medical appointments is crucial for patients with chronic conditions like HIV.9 Poor patient engagement in HIV care has been associated with lower viral suppression rates, particularly in adolescents and young adults. Virtual video visits may be an appropriate option for some patients who are looking for a safe and convenient alternative to in-person healthcare services.
Health Providers: Join the Telehealth Revolution
A call to integrate telehealth services into healthcare professional practice
HIV resource repository includes links to telehealth webinars, eLearning programs, and more
The use of telehealth services may help alleviate HIV treatment and retention barriers, including1,12:
Transportation challenges (limited access, long travel times, traffic)
Inflexible work schedules
HIV stigma and fear of being seen in the clinic setting
Reaching remote or hard-to-reach populations, including those in rural and prison settings
Reaching younger patients, who have grown up using digital apps, video conferencing, and other communication technologies
Best practices in telehealth
While telehealth services provide numerous benefits, implementing them into healthcare practices will require planning and preparation. Below are some best practices and resources to get started.
Understand telehealth laws and policies13
Take a close look at laws and regulations to understand what it will take to stay compliant, and investigate insurance health plans and policies regarding telehealth reimbursement to ensure your services are cost effective.
Explore technology options13
Expand your knowledge of the features you can include in your telehealth platform. You may be able to use existing software, or you may need a customized solution. To enhance your use of technology, you may need to invest in maintenance and tech support to smoothly implement everything.
Design for patients’ needs13
Develop a telehealth program and interface that patients and caregivers will find easy to navigate. Consider patients with health conditions and disabilities, patients with limited access to technology, and other patient groups who may have different needs.
Track program and patient data2
Set goals for program success and set measurable metrics to track progress of telehealth services. Consider qualitative metrics, such as “Has telehealth increased patient satisfaction?” Continue to look for ways to restructure and/or optimize the experience.
Telehealth for direct-to-consumer care
Best practice guides for how to conduct on-demand, at-home, virtual care, as well as behavioral health and emergency department care
AMA: Digital health implementation playbook series
Key steps and resources to facilitate the use of telehealth
Mitigating telehealth limitations
While telehealth will be a significant factor in advancing the future of healthcare, it can present challenges for patients with limited access to technology.3,12 Patients in the US who do not speak English as a first language or patients with less education may also be at a disadvantage.1 HCPs and healthcare organizations will need to work with vulnerable patient populations to overcome these barriers.
Other limitations (in situations where lab work is not required), such as the lack of a physical exam, may be mitigated by the advancement of wearable devices and artificial intelligence.3 Self-care equipment such as glucometers, blood pressure monitors, and other sensing systems have complemented the use of telehealth during the pandemic and, in addition, emerging technologies will continue to augment the use of telehealth in the future.
References:
1. Dandachi D, Freytag J, Giordano TP, Dang, BN. It is time to include telehealth in our measure of patient retention in HIV care. AIDS Behav. 2020;27:1-3. 2. American Medical Association Telehealth Implementation Playbook. AMA website. Published 2020. Accessed April 25, 2021. https://www.ama-assn.org/practice-management/digital/telehealth-implementation-playbook-overview 3. Doraiswamy S, Abraham A, Mamtani R, Cheema S. Use of telehealth during the COVID-19 pandemic: scoping review. J Med Internet Res. 2020;22(12):e24087. 4. Billing for telehealth during COVID-19. US Department of Health and Human Services website. Accessed April 25, 2021. https://telehealth.hhs.gov/providers/billing-and-reimbursement/ 5. HIPAA flexibility for telehealth technology. US Department of Health and Human Services website. Accessed April 25, 2021. https://telehealth.hhs.gov/providers/policy-changes-during-the-covid-19-public-health-emergency/hipaa-flexibility-for-telehealth-technology/ 6. Demeke HB, Merali S, Marks S, et al. Trends in Use of Telehealth Among Health Centers During the COVID-19 Pandemic — United States, June 26–November 6, 2020. MMWR Morb Mortal Wkly Rep. 2021;70 (7):240–244. 7. Telehealth and telemedicine. Centers for Disease Control and Prevention website. Accessed April 25, 2021. https://www.cdc.gov/phlp/publications/topic/telehealth.html 8. Budak JZ, Scott JD, Dhanireddy S, Wood BR. The impact of COVID-19 on HIV care provided via telemedicine—past, present, and future. Curr HIV/AIDS Rep. 2021;18:98-104. 9. Panel on Antiretroviral Guidelines for Adults and Adolescents. Guidelines for the use of antiretroviral agents in adults and adolescents with HIV. US Department of Health and Human Services. Updated February 24, 2021. Accessed April 25, 2021. https://clinicalinfo.hiv.gov/sites/default/files/inline-files/AdultandAdolescentGL.pdf 10. What is telehealth? US Department of Health and Human Services website. Accessed April 25, 2021. https://telehealth.hhs.gov/patients/understanding-telehealth/#benefits-of-telehealth 11. Synchronous direct-to-consumer telehealth? US Department of Health and Human Services website. Accessed April 25, 2021. https://telehealth.hhs.gov/providers/direct-to-consumer/synchronous-direct-to-consumer-telehealth/ 12. Rogers BG, Coats CS, Adams E, et al. Development of telemedicine infrastructure at an LGBTQ+ clinic to support HIV prevention and care in response to COVID-19, Providence, RI. AIDS Behav. 2020;20:1-5. 13. Best practice guide: Telehealth for direct-to-consumer care. US Department of Health and Human Services website. Accessed April 25, 2021. https://telehealth.hhs.gov/providers/direct-to-consumer/getting-started/#exploring-telehealth-technology-options |
HVUWCNT210001 June 2021
