Telehealth During COVID-19 Pandemic

A discussion on the impact and the use of telehealth in the management of patients during the COVID-19 pandemic.

Allison Butts, PharmD, BCOP: Something that we’ve not tapped into that applies to these subcutaneous agents in some ways is the impact of the coronavirus pandemic and how we perhaps treat patients a bit different today from how we did before. I’m wondering what the role of telehealth or telemedicine has been at your institution [at the University of Missouri Health Care] and how that’s impacted your early stage breast cancer patients.

Jacob Kettle, PharmD, BCOP: It all leans on innovation. Cancer care didn’t stop. Cancer didn’t stop growing because of the pandemic. What we have to do is find a way to keep moving forward in spite of challenges. When it comes to telehealth, COVID-19 [coronavirus disease 2019] was accelerant to the adoption of new technology, and it led a lot of our providers and patients to need it. Especially early on, we had a lot of hesitancy among patients to come in.

How can we bridge the gap when providers may be overburdened and need to squeeze in something? How can we overcome that gap from the patient side when they’re hesitant or concerned about coming in? We still need to keep up the monitoring aspect of active therapy, survivorship programs, and all those kinds of things. That continued relationship is critical. It’s a great tool to bridge the gap when we have some of these barriers.

We talked about this earlier with new targeted therapies versus the old antineoplastic diseases. I don’t think telehealth ever permanently replaces management, but is it a useful tool that we can implement in practice to help us overcome some of these shortfalls or difficult situations? Absolutely. We’ve become much more comfortable using it, and our patients have quickly become comfortable using it. These are trends that were probably in place that needed some type of an event to trigger adoption and acceptance. This has accelerated that timeline.

Allison Butts, PharmD, BCOP: I agree with you completely. Telecare has been around and on the table for quite a while, and it’s been slowly gaining steam. As you said, it needed an event to light the fire and make telemedicine a common practice. I agree with you as well that you’re never going to be able to replace a face-to-face encounter with a patient where it’s medically in your ability to do a physical exam, get your vital signs, and do all those things that you need to do to monitor a patient.

From the psychological side, we all know that, when taking care of cancer patients, there’s a lot of emotion there. Patients need some physical touch sometimes; they need to be comforted, and it’s very difficult to do that. I don’t think any provider out there wants to tell a patient that they have cancer over a computer screen and be unable to hand them a tissue or do anything to provide them some soothing comfort in that case. It’s necessary to bridge the gap, but it’s certainly not something ideal or something that people prefer in any way at this point.

Jacob Kettle, PharmD, BCOP: Right. Some of my biggest hesitancies are the things that you can hide via telehealth visit. It’s much easier to hide those things while sitting in a chair and holding yourself together for 15 minutes versus when I see a patient walk into clinic. A lot of times, that’s when issues reveal themselves.

Allison Butts, PharmD, BCOP: Right, agreed.

Jacob Kettle, PharmD, BCOP: I’m excited about it from a pharmacy perspective too because this is a great way to for us to leverage some more additional follow-up interaction with patients like education and adverse-effect monitoring. There are some real opportunities there too; it fits nicely in our wheelhouse to be able to take advantage of them.