Dr. Paul Wright, Senior Vice President and System Chair of the Neuroscience Institute, Nuvance Health
dedicated teacher may have a migraine but lacks time to see a headache specialist. A 75- year old recovering from a stroke and living alone is wondering how to stay safe in their home. An octogenarian living in a nursing home with worsening dementia feels scared in unfamiliar places but needs an evaluation from a neurologist.
Without telehealth, these individuals may delay or never get care because going to a doctor’s office is difficult for them. Not getting the care they need may negatively affect their health and quality of life.
Telehealth has many benefits, including enhancing access to healthcare, facilitating accurate and comprehensive clinical evaluations, preventing medical emergencies and improving stroke care.
Telehealth at Nuvance Health
Nuvance Health swiftly shifted to telehealth at the beginning of the COVID-19 pandemic in a matter of weeks — which was months’ worth of work — to continue caring for our patients. We implemented telehealth in our primary care and speciality practices across Connecticut and New York, including throughout our Neuroscience Institute. During the initial peak of the pandemic, nearly 90 percent of all medical practice visits were remote.
Today, Nuvance Health continues to offer telehealth visits at our medical practices so patients can get the care they need wherever is most convenient for them. About 12 percent of all medical practice visits are remote, except during COVID-19 surges, where there is an increase in telehealth visits to nearly 50 percent of all visits.
Enhancing Access to Healthcare
Telehealth has expanded access to care for our patients with neurological conditions, especially patients with limited mobility after having a stroke or from movement disorders like Parkinson’s disease.
Telehealth has also been beneficial for our patients with dementia. An in-office visit can cause a great deal of stress for patients with Alzheimer’s disease and their caregivers and loved ones. This neurodegenerative disease can cause patients to feel anxious and fearful in unfamiliar locations. They may have limited or no control of their bodily functions or faculties. Telehealth has enabled us to provide high-quality care to these patients while maintaining their comfort, safety and dignity.
Telehealth visits are a convenient and safe option compared to in-office visits during inclement weather. Winter weather in the Northeast, like ice and snowstorms, can make it difficult for patients and staff to get to the office. Additionally, weather that makes roads and walkways slippery may be particularly unsafe for patients with neurological conditions that affect their mobility.
We know that many people may delay or not seek medical care because of family or work commitments. We have been able to expand access to care through telehealth because it is convenient. Patients can have a secure and thorough remote visit with their doctor without leaving their home or office, like the busy teacher with migraine.
In some cases, remote visits can give clinicians a more accurate picture of a patient’s condition compared to seeing them in the office.
Patients with Parkinson’s disease are usually at their best in the doctor’s office. Caregivers or loved ones often say that the patient is “not like that at home.” This can be for a variety of reasons, including time of day or environmental factors.
Through a telehealth visit, we can see patients in their own environments, monitor real-time fluctuations in their symptoms and develop accurate treatment plans.
Patients that come to the office from facilities like nursing homes or long-term rehabilitation may have a transport companion that does not know their full medical history. These patients may also not be able to communicate their medical history completely — which is common for many patient populations.
For these reasons — in addition to the stress an in-office visit may cause the patient — it may be difficult to get a complete picture of their health and existing treatment plan.
Through telehealth, we have an opportunity to speak with members of their care team at the facility, from physicians and nurses to physical therapists and nutritionists. This can give us more information and, in turn, an accurate diagnosis and effective treatment plan.
"Telehealth has expanded access to care for our patients with neurological conditions, especially patients with limited mobility after having a stroke or from movement disorders like Parkinson’s disease"
Preventing Medical Emergencies
It would behoove everyone — especially as we age — to know how to prevent falls.
Falls are a major cause of preventable morbidity and mortality. According to the U.S. Centers for Disease Control and Prevention, falls are a leading cause of injury death for adults age 65 and older. Further, falls lead to nearly half of all traumatic brain injury-related hospitalizations in the United States.
Through a telehealth visit and with the patient’s permission, we can see inside their home, identify potential fall risks and help reduce them. For example, we can suggest they put items on a lower shelf that does not require a ladder to reach, remove tripping hazards like area rugs, or install grab bars in the bathroom.
Improving Stroke Care
Nuvance Health is fortunate to have specially trained stroke neurologists on our rapid response teams. Yet, like most hospitals nationwide, a stroke neurologist cannot always immediately be at the bedside when a suspected stroke patient first arrives at the emergency department.
Through telehealth, neurologists can remotely consult with emergency medicine clinicians to evaluate patients, rapidly diagnose stroke and order treatment. When it comes to stroke, time is brain, and rapid evaluation and treatment is critical to reducing the risk of long-term disability or death.
The Future of Telehealth
In-person healthcare visits will always have a purpose and value. We are now seeing that we can also provide a significant amount of care with major benefits through telehealth. In-person and remote care will continue evolving to improve patient experiences and outcomes and create organizational efficiencies.
I also foresee the evolution of telehealth with remote monitoring, which we are studying at Nuvance Health.
Through wearable devices, we can monitor a patient’s vital signs accurately and continuously. Remote monitoring can trigger early medical intervention before a serious medical concern occurs. Through remote monitoring, we can also track symptom fluctuations and adjust treatments accordingly.
I am encouraged by the adoption and expansion of telehealth and looking forward to the future of remote monitoring and other technological advances in healthcare.