Thread by @StefanKertesz

1/this study shows a massive shift to video and especially telephone care among Veterans after March of 2020. And it leaves me with key questions for vulnerable populations

https://twitter.com/herc_va/status/1326209353431572480

2/The striking thing is not just the upsurge in non-face-to-face care but the reality that most of it was telephone 📞 only. What does that mean?

3/First in any safety net system lots of the people we wish to serve are older and poorer and potentially less comfortable with using video tech, or they may well lack the data plan and devices

4/I don’t think every person can jump to video conferencing. And since that is reality we have to ask what telephone-only medical care can accomplish. My view? A mixed bag

5/With some of my older and disabled, cognitively impaired or mentally ill patients, here are some things I need to know, but can’t get by phone: their gait, their ability to attend to me and the nurses, their facial expression and engagement. On phone-only visits, that is gone

6/That is separate from the reality that I can’t physically examine the patient safe for tone of voice

7/But here is the really difficult research thing: how would we document that a switch from in-person care to video or phone-only care had any consequences? It is really really hard

8/if you look for evidence that medical conditions got worse, well, guess what - you might not have a chance to find out because we are not seeing the patients

9/ if you say you wish to see evidence of hospitalizations that might have been prevented, then the analysis will be messed up because there are studies all over the world showing people stayed home with conditions that normally require hospital care

10/we should understand that a transition to virtual care has happened. It will never fully go back. And we should be cautious in assuming that we know whether it was good or bad, and for whom it was. We need research, focused on vulnerable populations, and I hope to do it