A few weeks ago I was asked to participate in a telehealth session with a physician assistant to discuss an upcoming visit to a local Anchorage clinic. I couldn't help but notice that it looked like she was sitting in her home, maybe at the kitchen table. Being a curious kind of guy, I was compelled to ask her about where she was. Yes indeed, she was sitting at her kitchen table...in Oklahoma.
Turned out that she used to live in Alaska and worked at that clinic, then moved out of state a few years ago. They recently hired her back to do exclusively telehealth patient encounters. On the one hand I am still in awe of this Star Trek holodeck-type technology. On the other hand, telehealth has become commonplace in Alaska and across the nation.
According to a recent U.S. Census Bureau Household Pulse Survey taken earlier this year, telehealth services from doctors, nurses and other health professionals were utilized by 22% of Americans in a four-week period. But it's important to point out that not all of it was delivered by whiz-bang Star Trek technology. Fully 9% of Americans had a phone appointment in this period, while 11% used more advanced video technology.
The Pulse survey produced a number of interesting factoids, knowledge of which is certain to make you popular at your next social gathering. Here's one: Of all age groups surveyed earlier this year, seniors 70 years of age and above were the most frequent users of telehealth services at 24% to 25% in a recent four-week period. I'll bet you thought younger folks would be the heavy users, but we seniors are on the bleeding edge (oops, perhaps not the best of analogies) of this technology. And this is even more astounding in light of the fact that a mere 4% of medical encounters by seniors were telehealth in 2019.
Among seniors, phone users had a bit of an edge over video users, so don't be shy if video technology is not your thing. In fact, about a year ago I was scheduled to have a video conference with my primary care provider. While I think of myself as a fairly knowledgeable computer user, I could not make the video connection work. I started to go down the troubleshooting wormhole, but the wise physician suggested we just go POTS (Plain Old Telephone Service), so we did. It worked just fine.
Perhaps it is not terribly surprising to find that low-income Americans were more likely to use telehealth services. After all, online services are sometimes less expensive and usually easier to access than office visits.
Among every demographic explored in the Pulse survey, transgender Americans reported the highest rate of telehealth use. Fully 42% of transgender Americans had a phone or video appointment with a doctor, nurse or other health professional in the past four weeks – nearly twice the percentage of the general public.
Matthew Wetschler, who co-founded Plume - a virtual gender-affirming health care provider group - told Fierce Healthcare in September 2020 that the platform was designed to help transgender patients who prefer a continuous connection with a specific care team. He noted that traditional care can be a negative experience for this vulnerable population facing potential discrimination and harassment.
Special kudos to the Alaska Native Tribal Health Consortium in the Alaska world of telehealth. They have been actively serving more than 180,000 Alaska Native and American Indian people with innovative telehealth services since 2001. The latest innovation is the ANTHC Behavioral Health Wellness Clinic. The telehealth service is a primary behavioral health clinic designed to meet the patient's everyday behavioral health needs. The BHWC serves Alaska Native and American Indian individuals and families throughout the state of Alaska. Clients are able to begin care quickly with minimal paperwork.
Finally, a word about younger females in our families and the special value of telehealth. According to the nonprofit Power to Decide, more than 30,000 Alaska women live in areas where they don't have full access to birth control. The Pill Club is a digital healthcare provider focused on contraceptives that expanded to Alaska earlier this year. As reported by KSTK in Wrangell, Stephanie Swartz is Pill Club senior director of policy and public affairs. She was quoted as saying, "Telehealth really has the potential and the promise to reach people who have historically struggled to receive the care that they deserve – whether that's because providers and centers are far away or because they felt like providers just have not paid attention to their needs and their personal conditions."
Perhaps by way of summary we could alter the Star Trek tagline: "Telehealth – boldly going where no healthcare has gone before."
Lawrence D. Weiss is a UAA Professor of Public Health, Emeritus, creator of the UAA Master of Public Health program, and author of several books and numerous articles.
