ACP Recommends Switching to Telehealth Calls During COVID-19 Pandemic

Robert McLean, MD

As virtually every hospital and healthcare provider across the country is dealing with the fallout of the coronavirus disease 2019 (COVID-19) outbreak, the American College of Physicians (ACP) is reassessing how non-urgent, in-person medical appointments are conducted.

In a new release, the ACP suggests moving this group of patients entirely to virtual visits or ultimately delaying the visits to avoid the unnecessary risk of contracting the highly contagious disease.

While even during a pandemic non-infected patients are going to need medical care, the new policy guidelines call for doctors to maintain access to clinical services in environments that are safe for both the patient and medical personnel.

“While the need to see a particular patient in person is based on multiple complex factors, physicians should work to transition patients who do not need to be seen in person to a virtual visit or else consider delaying the visit until such time as the benefits are outweighed by the harms that could occur when timely care is not delivered,” the new policy states.

The ACP recommends doctors should provide an explanation to all patients on these new changes and cancel all elective and non-urgent procedures schedules.

The ACP also has contingencies for lower income and elderly patients who do not have access to video teleconferencing technology.

Here, the organization recommends traditional audio only phone calls will have to suffice for the time being.

However, they also advocate that government and telecommunication entities should immediately expand their coverage and payment policies to include both video-enabled and audio-only phone calls, effective retroactive to President Donald Trump’s declaration of a national emergency.

This would allow physicians to quickly convert routine and preventive visits to a telephone or telehealth visits with the overwhelming majority of patients.

However, these services remain necessary in some form because the regular ongoing evaluation of patients with chronic health conditions can prevent further deterioration, which could lead to unnecessary emergency room or hospital care visits.

“Patients and physicians both need to follow the advice of public health experts to practice social distancing, avoiding contact with others unless absolutely necessary. This includes interactions that happen at in-person medical visits,” Robert McLean, MD, MACP, president, ACP, said in a statement. “While in-person visits are important to maintaining a strong patient-physician relationship, as well monitoring health issues, we are in an unprecedented situation right now.”

The ACP is the largest medical specialty organization in the US, with members in more than 145 countries. The membership includes 159,000 internists, related subspecialists, and medical students.

One of the major issues linked to the spread of COVID-19 is the mental health impact overcrowded facilities will have on nurses, doctors and other frontline workers.

Recently, Jianbo Lai, MSc, and a team of China-based investigators used data from >1200 healthcare workers to assess the magnitude of mental health outcomes and associated factors among those treating patients who were exposed to the virus in China.

The team found that among the Chinese workers exposed to COVID-19, women, nurses, those in Wuhan, and frontline healthcare workers had a greater risk of worsening mental health outcomes than average.

The findings suggested that such individuals may need psychological support or interventions.

Lai, from the Department of Psychiatry at Zhejiang University School of Medicine in Hangzhou, China, and colleagues collected demographic data and mental health measurements from 1257 healthcare workers in 34 hospitals in China from January 29, 2020 to February 3, 2020. The investigators included healthcare workers in hospitals equipped with fever clinics or wards for patients with COVID-19.

Nurses, women, frontline workers, and those in Wuhan self-reported experiencing more severe symptoms levels (severe depression among physicians vs nurses: 24 [4.9%] vs 54 [7.1%]; P = .01; severe anxiety among men vs women: 10 [3.4%] vs 56 [5.8%]; P = .001; severe insomnia among frontline workers vs second-line workers: 9 [1.7%] vs 3 [0.4%]; P <.001; severe distress among workers in Wuhan vs Hubei outside Wuhan and outside Hubei: 96 [12.6%] vs 19 [7.2%] among participants in Hubei outside Wuhan and 17 [7.2%] among those outside Hubei; P <.001).