Telehealth transcends the boundaries of healthcare facility walls. The use of telehealth can provide access to quality healthcare providers despite the patient’s location. This increased access to healthcare resources allows patients to connect with providers, have health conditions remotely monitored, and improve patient outcomes. The implementation of telehealth in diverse areas of healthcare increases access to services that may not be available in a specific geographical area and highly specialized care.
Because of lockdowns, social distancing, and other measures aimed at slowing the spread of COVID 19, marginalized groups and groups disproportionately affected by social determinants have been unduly affected and face increased barriers to accessing equitable healthcare which has significantly shifted to telehealth. Barriers to consider include the availability of internet access, housing, and reimbursements for telehealth (Smith & Raskin, 2021). Social determinants may contribute to the digital divide and impact access to the technology needed for telehealth including internet service, computers, or cell phone service with data plans. Furthermore, internet access may be limited or unavailable in many remote areas further limiting telehealth options.
In addition to considering access to the technology needed for telehealth, attention must be given to health literacy, technology literacy, and the ability to convert the knowledge gained into positive outcomes (Shaw et al., 2021). Though telehealth options are becoming readily available and widely used, healthcare providers must also consider the patient’s self-determination and willingness to engage in telehealth. Telehealth technologies should provide patients with a sense of autonomy, competence, a sense of choice, belonging, and confidence (Dewar et al., 2017). Housing also factors into the use of telehealth. A lack of sufficient housing directly relates to internet availability but also limits the privacy needed during telehealth visits.
As the use of telehealth continues to expand, policy regarding telehealth services must be updated, implemented, and expanded to cover the service. Differing state laws regarding the establishment of a healthcare relationship, provider licensure laws, and reimbursement hamper the ability to expand telehealth across state lines (Sklar & Robertson, 2020). Telehealth is a viable option for increasing access to healthcare, decreasing healthcare costs, and improving patient outcomes. Therefore, state and national policy should mitigate barriers to expanding telehealth.
In the given scenario, each patient can benefit from telehealth services. Mr. Kasich and Mr. Lane benefit from the remote monitoring of blood pressure and blood glucose levels since Mr. Kasich lives 40 miles from the nearest healthcare provider and Mr. Lane may not be near his home or healthcare provider as he is a long-haul truck driver. Mr. Kasich has the advantage of having his wife available to assist him should the need arise. In the case of Mr. Lane, the nurse must consider legal and ethical ramifications should Mr. Lane have an emergency while driving alone. In terms of resource allocation, the nurse would have to make an ethical decision on which patient would benefit most from the telehealth monitor if only one was available. Mr. Kasich is elderly, has advanced heart failure, and has an unknown state of lung cancer whereas Mr. Lane is younger and does not have cancer.
Dewar, A., Bull, T., Malvey, D., & Szalma, J. (2017). Developing a measure of engagement with telehealth systems: The mHealth Technology Engagement Index. Journal of Telemedicine and Telecare, 23(2), 248-255. https://doi.org/10.1177/1357633X16640958 (Links to an external site.)
Shaw, J., Brewer, L., & Veinot, T. (2021). Recommendations for health equity and virtual care arising from the COVID-19 pandemic: Narrative review. JMIR Formative Research, 5(4), 1-13. https://doi.org/10.2196/23233 (Links to an external site.)
Sklar, T. & Robertson, C. (2020). Telehealth for an aging population: How can law influence adoption among providers, payors, and patients? American Journal of Law and Medicine, 46(2-3). 311-324. https://doi.org/10.1177/0098858820933501 (Links to an external site.)
Smith, S. & Raskin, S. (2021). Achieving health equity: Examining telehealth in response to a pandemic. The Journal for Nurse Practitioners, 17(2), 214-217. https://doi.org/10.1016.j.nurpra.2020.10.001