The fundamentals of telehealth in population health management

In this editorial response, we provide a discussion on the fundamentals of teleconsultations in the field of Population Health Management as it relates to Kaissar et al. article which explored physicians’ satisfaction with the use of teleconsultations in France (1). The authors highlighted the significance of and growing need for telehealth during the coronavirus disease 2019 (COVID-19) pandemic as well as the importance of delivering safe and effective care through teleconsultations. The move from traditional clinical practice to socially distanced digital health, has changed the dynamic of how patients are cared for with acute and chronic healthcare needs (2). Population health management is a care approach that is reliant on collaborative data and interprofessional co-production to manage patients with long-term chronic illnesses within community settings (3). The use of telehealth practices in Population Health Management through teleconsultations is an essential method for delivering continued and collaborative care beyond the clinic room (4), and Kaissar et al. emphasized how physicians’ rated satisfaction using teleconsultations and its influences for widespread use. According to the data, physicians reported that telemedicine may not be effective for all patients due to concerns with an impact on the doctor-patient relationship and a potential increase in medical errors. Additionally, physicians reported an increased willingness to use telemedicine technologies when involved in its development.

To gain a deeper understanding of physicians’ satisfaction with teleconsultations, Kaissar et al. used a descriptive cross-sectional survey to explore physicians’ opinions, practice patterns, expectations and predictions of continued use of teleconsultations in future practice. The participating physicians within Toulouse University Hospital were familiar with utilizing this method of delivering care and the COVID-19 pandemic heightening its use. It was evident from the findings that innovative and contemporary ways of delivering healthcare was an influencing factor for physicians’ satisfaction. Novel healthcare practices in Population Health Management have been identified as an essential method of reaching populations in vast and rural communities, and the use of telehealth within Kaissar et al. study has demonstrated its significance particularly in the midst of the COVID-19 pandemic (5). Within this study, the authorized use of digital tools to perform teleconsultations was identified to be a significant influencing factor on physicians’ perceptions of satisfaction, which supports the idea that telemedicine may not significantly impact the provision of health services and patient care (6), and facilitates integrated care provision when managing the health of a population. Quality assurance was also an influencing factor within the study, ensuring remote care mirrored that of face-to-face consultations and maintaining high-quality health care provision. Collaborative and interprofessional care with the use of digital health technologies and telehealth is a sustainable method for patient decision-making, diagnosis of chronic diseases and treatment processes within Population Health Management (7). It is evident from Kaissar et al. study that, the benefits of teleconsultations outweigh potential limitations.

With any novel method of delivering healthcare, facing challenges, and overcoming limitations are expected. It was evident that Kaissar et al. identified accessibility and technical issues such as sound quality, network coverage and video connection as some of the limitations of teleconsultations. There are evidence-based recommendations that highlight the importance of conducting patient assessments prior to using teleconsultations, as well as evaluating the level of engagement and the assessment of telehealth efficacy for long-term use (8). Digital technology has become widely used in Population Health Management however, recognizing the potential limitations as identified by Kaissar et al. encourages the need for further quality assurance processes for telehealth delivery. Telemedicine has been regarded as an essential method for patient review and follow-up (9), but presents challenges for individuals who are not digitally competent, who lack digital skills and whose comprehension of how to use health technologies are diminished by technophobia (10). Although Kaissar et al. reported technical issues at 20%, it still serves to underscore the fact that technical issues may arise at any point during a teleconsultation which could occur from the receiver or sender’s side of communication.

The Population Health Management approach in caring for people with chronic diseases, has been a care delivery model that has readily accepted and benefited from the integration of telehealth, health telecommunications and digital technology (10). Population Health Management functions as a collaborative, interprofessional and co-productive management strategy for individuals living with long-term chronic illnesses beyond institutional settings (11). Patients with chronic diseases within different population groups have relied on digital health platforms such as teleconsultations as an effective method for obtaining treatment and follow-up and reducing in-person visits to healthcare centers (11). Kaissar et al. have highlighted in their study that, the use of teleconsultations is becoming widely adopted by physicians and may enhance traditional healthcare practices in the future. This is a critical finding relevant to the complex care needs of patients within various population groups, much like those presenting with co-morbidities. Promoting self care skills such as self-monitoring of chronic illnesses through the use of telehealth coaching, has supported behavioral changes that enhance health outcomes (12).

This editorial response has highlighted that teleconsultations are an important care management practice within the field of Population Health Management and Kaissar et al. have demonstrated its significance by exploring practitioners’ satisfaction with utilizing this service delivery model. The findings illuminate the intricate nature of influencing factors that promote the use of teleconsultations and recognize the limitations of its use. Further studies on this topic are essential to expanding our conceptualization of teleconsultations and fundamental to the advancements in the use of such technology in providing service provisions across communities and population health settings.

Acknowledgments

The authors would like to thank Dr. Jacqueline Guendouzi, Professor, Department of Health and Human Sciences, Southeastern Louisiana University, for granting assigned time to conduct this editorial response.

Funding: None.

Footnote

Provenance and Peer Review: This article was commissioned by the editorial office, Journal of Hospital Management and Health Policy. The article did not undergo external peer review.

Conflicts of Interest: All authors have completed the ICMJE uniform disclosure form (available at https://jhmhp.amegroups.com/article/view/10.21037/jhmhp-23-19/coif). The authors have no conflicts of interest to declare.

Ethical Statement: The authors are accountable for all aspects of the work to ensure that questions related to the accuracy or integrity of any part of the work are appropriately investigated and resolved.

Open Access Statement: This is an Open Access article distributed in accordance with the Creative Commons Attribution-NonCommercial-NoDerivs 4.0 International License (CC BY-NC-ND 4.0), which permits the non-commercial replication and distribution of the article with the strict proviso that no changes or edits are made and the original work is properly cited (including links to both the formal publication through the relevant DOI and the license). See: https://creativecommons.org/licenses/by-nc-nd/4.0/.

References

1. Kaissar S, Zara S, Fabrice F, et al. Physicians’ satisfaction with the use of teleconsultation in France. J Hosp Manag Health Policy 2023;7:1.
2. Figueiredo AA, Fernandes A, Fornari A, et al. Interim Guidance for Urodynamic Practice during COVID-19 Pandemic. Int Braz J Urol 2021;47:178-84. [Crossref] [PubMed]
3. Cronin CE, Franz B, Schuller KA. Expanding the Population Health Workforce: Strategic Priorities of Hospital Organizations in the United States. Popul Health Manag 2021;24:59-68. [Crossref] [PubMed]
4. Buvik A, Bergmo TS, Bugge E, et al. Cost-Effectiveness of Telemedicine in Remote Orthopedic Consultations: Randomized Controlled Trial. J Med Internet Res 2019;21:e11330. [Crossref] [PubMed]
5. Calton B, Abedini N, Fratkin M. Telemedicine in the Time of Coronavirus. J Pain Symptom Manage 2020;60:e12-4. [Crossref] [PubMed]
6. Somani BK, Pietropaolo A, Coulter P, et al. Delivery of urological services (telemedicine and urgent surgery) during COVID-19 lockdown: experience and lessons learnt from a university hospital in United Kingdom. Scott Med J 2020;65:109-11. [Crossref] [PubMed]
7. Novara G, Checcucci E, Crestani A, et al. Telehealth in Urology: A Systematic Review of the Literature. How Much Can Telemedicine Be Useful During and After the COVID-19 Pandemic? Eur Urol 2020;78:786-811. [Crossref] [PubMed]
8. Sacco E, Gandi C, Li Marzi V, et al. Extensive impact of COVID-19 pandemic on pelvic floor dysfunctions care: A nationwide interdisciplinary survey. Neurourol Urodyn 2021;40:695-704. [Crossref] [PubMed]
9. López-Fando L, Bueno P, Carracedo D, et al. Management of Female and Functional Urology Patients During the COVID Pandemic. Eur Urol Focus 2020;6:1049-57. [Crossref] [PubMed]
10. Grimes CL, Balk EM, Crisp CC, et al. A guide for urogynecologic patient care utilizing telemedicine during the COVID-19 pandemic: review of existing evidence. Int Urogynecol J 2020;31:1063-89. [Crossref] [PubMed]
11. Mehrotra A, Paone S, Martich GD, et al. A comparison of care at e-visits and physician office visits for sinusitis and urinary tract infection. JAMA Intern Med 2013;173:72-4. [Crossref] [PubMed]
12. Hoppe KK, Smith M, Birstler J, et al. Effect of a Telephone Health Coaching Intervention on Hypertension Control in Young Adults: The MyHEART Randomized Clinical Trial. JAMA Netw Open 2023;6:e2255618. [Crossref] [PubMed]