Telehealth has been a vital part of breaking down the barriers between patients and clinicians during the COVID-19 pandemic. Like other specialties, pulmonology has benefitted from these growing services, but there may be reason to apply extra caution when deploying virtual care to help patients with chronic respiratory conditions.
During RubiconMD’s webinar last week, Pulmonologist Mark Metersky, the Chief of Pulmonary, Critical Care and Sleep Medicine and the Director of the Center for Bronchiectasis Care at the University of Connecticut Health Center, provided an update on COVID-19 and spoke to attendees about the many different ways to remotely monitor respiratory patients.
Although he’s seen telehealth successfully deployed with nothing more than a laptop or smartphone, Dr. Metersky did mention that tools and methods like a remote stethoscope and remote spirometry can also be helpful for these patients.
When it comes to virtually diagnosing respiratory conditions, Dr. Metersky, MD, FCCP, FACP, said he’s seen innumerable patients with a false diagnosis of asthma or COPD. For this reason, he prefers to rely on an in-person visit and testing to diagnose either condition. When it comes to virtually managing these conditions, though, Dr. Metersky had several recommendations.
According to studies Dr. Metersky briefly recapped during the webinar, on average, telehealth was able to improve both adherence to anti-asmtha drugs and inhaler technique - two of the most common reasons for complications.
One study showed that, at baseline, 77% of inhaler technique observations revealed inadequate technique, 33% of which were critical errors. After telemedicine interventions, the number of critical errors went down to 9%.
When helping patients improve their inhaler technique remotely, Dr. Metersky recommended using videos from trusted clinical sources to help give them a visual. He also prefers for patients to have a spacer on their inhaler.
Despite several studies aiming to prove so, Dr. Metersky said there’s no evidence to show that telemedicine is better at managing asthma than in-person visits and that outcomes for both telehealth and face-to-face visits are similar. However, that doesn’t mean that telehealth is not beneficial in certain settings. “There are many advantages,” Dr. Metersky said, noting that patients won’t have to take time off of work or travel long distances just to see specialists.
Chronic obstructive pulmonary disease (COPD) is one of the top killers of patients across the world, Dr. Metersky said. It would seem that makes it a top contender for telehealth, but there is reason to be extremely cautious with that approach.
Studies showed a significant increase in the mortality rate of patients who received telecare when compared to those who received in-person care. While the research team was not able to pinpoint an exact reason for the increase, the findings suggest clinicians should proceed with caution when implementing telehealth for COPD patients.
One area that Dr. Metersky thought telehealth could benefit is pulmonology rehabilitation. He said this resource is underused, with one of the largest barriers being transportation. Virtual care could eliminate that hurdle and make pulmonary rehabilitation more accessible.
Dr. Metersky did mention several ways he thinks telehealth can help mitigate COPD exacerbations including more frequent monitoring for early detection, facilitating collaborative self-management, and assessing adherence to treatment. However, he never shied away from the initial warning, frequently reminding webinar attendees they must proceed with caution. “These patients are very vulnerable,” he said.
When virtually assessing patients who may have COVID-19, Dr. Metersky recommended to focus on their history with the ultimate goal of keeping patients with a mild form of the disease out of doctor’s offices and hospitals.
One key indicator of COVID-19’s severity is dyspnea, but it can be difficult to tell how much this is affecting a patient over the phone or through video. To mitigate this, Dr. Metersky recommended asking specific questions. What does the patient struggle to do now that they could do 3 months ago? For example, is the patient becoming short of breath when:
Walking on a flat surface?
Walking up one flight of stairs?
Physical indicators can also be used, including:
Assessment of general appearance
Have them take their temperature and pulse
Are they confused or lethargic?
Are they up and moving around or lying in bed?
Are they speaking in full sentences?
Attempt to estimate respiratory rate
Based on our webinar with Dr. Metersky, deploying telehealth to help manage chronic respiratory conditions can be very beneficial, but needs to be done cautiously, especially for patients with COPD. Although it may not be better than in-person visits, care received through telehealth can often be just as good and more convenient for the patient.
That convenience is part of what Dr. Metersky thinks will make telehealth stick around even after COVID-19 is controlled. Patients have now seen that they can get at least the same level of care without leaving their homes.
“The genie is out of the bottle,” he said.
To watch the full webinar with Dr. Metersky, go to https://www.rubiconmd.com/cme.
Please note this blog was written on May 5, 2020, the post may be updated as the news evolves.
Disclaimer: RMD is not a healthcare provider and the opinions provided by the Specialists are not medical diagnoses, treatments or prescriptions of any kind. In addition, the Specialists never establish a doctor to patient relationship. Any information provided is merely educational material for the clinician to better understand how a relevant Specialist would approach a similar case and use the information for their own knowledge. RMD makes no representations regarding the quality of the information provided by the Specialists. The Specialists are not officers, directors, agents, members, or employees of RMD.