The Promise of Telehealth

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Michelle Troche: Because of the pandemic, many of us have experienced the feeling of needing or wanting to see a physician or other healthcare provider but feeling that the risk is just too high to do so in person. And for many, that feeling is not new. For example, people with diseases that make it difficult to move around or which compromise their immune systems have always had to worry about the burden or even health consequences of going to the doctor. I've spent most of my career working with patients who have neurodegenerative disease and in particular Parkinson's disease. I'd like you to meet George. 

George Lonsberry: First of all, my name is George Lonsberry, I am 83 years old and we live in New Jersey and healthcare is especially important for me with the fact that I have Parkinson's and a few other issues, so it's important that I be able to get in touch with whomever I need to be touch with, medical wise. 

Michelle Troche: People with PD can find it quite burdensome to come to clinics but they require consistent neurology follow-up and interdisciplinary care, including but not limited to speech language pathology, which is my area of specialty, physical therapy, occupational therapy, neuropsychology and more. This care is essential to maintaining health, quality of life, and slowing the progression of disease.

George Lonsberry: When we live in New Jersey, that entails about two hours, you would always have to plan on two hours each way because we have to plan for traffic so it was always a big thing. And then you got the expenses, the bridge expense you got the expense of the parking and so on. So that was something that happens with the physical visit and then being in physical condition to get there. I mean, if we go to the Neurological Institute, we got to walk up that hill.

Michelle Troche: When the pandemic hit most neurology clinics felt it was not safe to bring patients in for their visits and the same extended to other healthcare providers.

George Lonsberry: Well, we were afraid, you're not gonna be able to get the appointments that you needed. The first thing that you have to be concerned about is the, setting it up. In other words is the first time you go through it can be very confusing if you've never done it before - all the clicking and things you gotta to do to get there. I think the introduction is, is a little difficult, but once you're there and you've opened it up, then I think that, you know, you start to make that relationship between the presenter and the patient.

Michelle Troche: A survey by Columbia University Parkinson's Disease Center of Excellence and the Parkinson's Foundation found that telehealth use increased from 10% to 64% during the pandemic and of those patients, 46% reported that they preferred to keep using telehealth even after the pandemic. In fact, prior to the pandemic, many clinicians, patients and families were afraid that healthcare via telehealth would be worse than in-person services. However, they lived the experience with telehealth during the pandemic, and that changed their perspective. This is important because now different surveys have in fact confirmed that people have had the taste of how convenient and good telehealth can be. And many may not want to go back to all in-person healthcare after the pandemic.

Elizabeth Lonsberry: I know it's been an incredible experience for George and for me, the fact that he wasn't able to get physical therapy and Chelsea, I don't know if you know Chelsea, but God bless her. She's, she's at, at Columbia, she was able to diagnose and, sent him constant demonstrations on what he should do physically. He had low blood pressure. So whether you needed stockings, or, you know, abdominal belts or whatever, she'd look it up and tell us what to buy. So is it wonderful? Yes. Could you do this as a, for cardiologists? No. You know, you need that EKG.

George Lonsberry: So I think there's going to be various conditions where you're going to want to go one way or another. Especially right now, I'm going through some walking difficulties. So I think that might quite possibly be another option, where it feels physically hard to do.

Michelle: The major uptake in telehealth during the pandemic has also served as a necessary catalyst for increased research related to telehealth. Our lab is one of those groups now researching telehealth. We and many others have become particularly interested in the reliability of assessments via telehealth, their validity as compared to in-person services, and the feasibility of providing treatment which is comparable to in-person service via telehealth. How do we ensure that a modality which may have the possibility to increase access to quality health care does not actually result in greater healthcare inequity? And although it seems pretty straightforward, you have a phone or a computer and ta da - you have great telehealth care, the reality is that we know there are plenty of barriers. One is the availability of Broadband Internet with sufficient app and download speed, as is access to necessary devices like computers or iPads, and beyond that healthcare providers and patients and their families need to be able to interact effectively. So my hope is that when this pandemic is behind us, we continue to remember how important telehealth was and should continue to be in allowing health access to all of us in need of critical healthcare. And that we do the important work to ensure that those services are accessible to all.

See more:

• At Teachers College Laboratory for the Study of Upper Airway Dysfunction
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Read more:

• On Telehealth in Michelle Troche's coauthored articles 
  • Objective and Subjective Clinical Swallowing Outcomes via Telehealth: Reliability in Outpatient Clinical Practice
  • Obtaining Objective Clinical Measures During Telehealth Evaluations of Dysarthria