patient care perspectives

Telehealth in Sickle Cell Disease

by Julie Kanter, MD

Overview

Telehealth enables clinicians to treat more patients with sickle cell disease (SCD) who may live at a great distance from an SCD specialist. Some patients may be effectively treated almost exclusively via telehealth, while others may need to be seen in person more frequently.

Expert Commentary

Julie Kanter, MD

Associate Professor, Division of Hematology and Oncology
Director, Adult Sickle Cell Program
Codirector, Lifespan Comprehensive Sickle Cell Center
University of Alabama at Birmingham
Birmingham, AL

“Now that many hospitals have the infrastructure for telehealth, there is an opportunity to optimize its use, with the goal of extending access to care most effectively." 

Julie Kanter, MD

Prior to COVID-19, telehealth was not as widely used as it is now, in part because of concerns regarding logistics and a potential strain on the system. However, now that many hospitals have the infrastructure for telehealth, there is an opportunity to optimize its use, with the goal of extending access to care most effectively.

When COVID-19 emerged, we were fortunate at the University of Alabama at Birmingham in that we already had an established telehealth network. As more hospitals developed telehealth capabilities, our EMBRACE (ie, the Education and Mentoring to Bring Access to Care) network, our southeastern network funded by the Health Resources and Services Administration to improve access to high-quality care for patients with SCD, was able to study the use of telehealth during the pandemic for those with SCD. With EMBRACE, we have received positive responses from our patients who have used telehealth. Many individuals whom we care for live more than 2 hours away, so they appreciate this opportunity.

Telehealth is implemented differently in various settings. For instance, we have been using telehealth while also scheduling in-person appointments every second or third visit. Some of my colleagues have rooms in their clinics dedicated to telehealth and use the same workflow that is required for an in-person visit.

Differentiating between patients who can be treated almost exclusively via telehealth and those who may need to be seen in person more regularly is important. Another goal has been to adapt telehealth to allow for patients to receive intravenous pain medicine, if needed at an affiliate clinic. In South Carolina, we have had success with a small clinic managed by an advanced practice provider, where the patients can come in to get pain medicine and transfusions within that clinical setting, and then I can see them via telehealth if they need to be seen.

Telehealth advantages include that it enables clinicians to treat more individuals who live farther away. It also allows specialists to collaborate with other clinicians remotely so that the care of patients with SCD can be shared, without the need for travel. Patients who use telehealth do not have to visit in person as frequently, which eliminates some of the transportation challenges.

Looking to the future, I would note the importance of keeping telehealth paid for (by third-party payors). We really need the payors to recognize that this is a big deal. The health economics side of the story is interesting, as there are some wins and some losses. It truly does extend access to care for patients who live in more rural regions and for those for whom transportation is an issue, and I hope that this is widely recognized. While telehealth is not for every patient, there is certainly a place for it.

References

Mayo Clinic. Telehealth: technology meets health care. Accessed May 19, 2021. http://www.mayoclinic.com/health/telehealth/MY01693

McQuillan S. Telemedicine: pros and cons for you. Accessed May 19, 2021. https://www.qualityhealth.com/healthy-aging-articles/telemedicine-pros-cons-you?rf=32471

Yan H, Gardner R, Baier R. Beyond the focus group: understanding physicians’ barriers to electronic medical records. Jt Comm J Qual Patient Saf. 2012;38(4):184-191. doi:10.1016/s1553-7250(12)38024-0

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