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Consumers’ willingness to seek care and use telehealth: What providers need to know

Jen Volland, VP Program Development, NRC Health

Safety. It’s the second level of Maslow’s hierarchy of needs—which speaks to what motivates individuals and society at large—and includes the feeling of bodily security (including physical health), mortality, and resources. The only level that’s more important is that of our physiological needs, such as food, water, and sleep. According to Maslow’s theory, in order to address higher levels on the hierarchy of needs, a person must first feel that their lower needs are fulfilled.

Why is this important? Well, for one thing, it means that individuals will not bother mastering safety procedures until their physiological needs have been met—even during a pandemic. At its most basic level, the coronavirus attacks us physiologically: affected individuals have difficulty breathing, they experience loss of appetite and an inability to taste food, and their sleep patterns become disrupted. This is the tier that front-line hospital workers are handling when they treat patients with active symptoms.

Providers, however, play a role at the second tier of the hierarchy—safety. This is the level at which your patients’ and community’s opinions matter. It’s also the level at which we’re seeing the most resources being deployed and fears being addressed—the debate over healthcare workers and individuals wearing masks; issues of unemployment and requests for resources; discussions of mortality rates; concerns over the possibility of not having rent this month, or closing a business, or losing a home.

As part of the medical team that directly addresses this level of the hierarchy, medical social workers are an excellent in-office and remote resource for patients during this time. They can help patients find access to healthcare resources that they may need—such as affordable medications or prescription card-discount programs—and other sources of community support. They can often also help with the physiological tier, by providing suggestions for resources like food banks.

Presently, the provider role sits predominantly at the second tier: ensuring bodily safety. And this is a serious concern right now. From NRC Health’s research data between March 13 and 17, 50% of consumers feel that going to the doctor is riskier during the coronavirus pandemic.

An additional 9% of consumers noted that they would not seek care from a physician during the pandemic because of the level of risk. While that may seem a small percentage, it can add up quickly when looking at the number of patients that a doctor has on their panel. Given consumers’ concern for their safety in the physical office setting, telehealth should be considered as a way to help patients feel more secure about getting the help they need.

Research conducted by NRC Health also indicates that 68% of males and 72% of females will have a change in their everyday routine during the pandemic and will stop going to the doctor or urgent-care department for routine care. While in some areas this may be desirable to reduce patient volumes, some states are not seeing the same numbers that are being observed on the coasts. It also places the patient in the position of determining what “routine care” is, rather than having that be assessed by a physician—and some things that may seem a simple annoyance to a patient are symptoms of a more serious condition. Some cohorts—millennials, for example—tended to delay care even before the pandemic hit, and while it is reasonable for patients to be concerned about being seen in a clinic at this time, delaying care further can create serious issues in the long term.

Between April 3 and 6, NRC Health examined what types of care were most being delayed. Primary and specialty care combined (i.e., seeing a provider) was the top response across all age cohorts; percentages ranged from 29.8% to 44.2% across the generations, with ages 40–55 and 56–74 being the most likely cohorts to put off needed services. Percentages for other services, such as non-emergent dental care, were lower as expected.

Fortunately, telehealth gives many of these patients a way to be seen. Some providers had their own apps for conducting telehealth appointments before the pandemic; since the pandemic hit, we’ve seen providers increase their efforts to make accessing telehealth as easy as possible by offering it through multiple platforms, including Zoom and other video-chat programs. This gives patients a choice in the app they use, which can make them feel more empowered to seek care. Still, those most likely to put off services during the pandemic—people in the 40-to-74-year age range—may need guidance on how to download an app or log in and establish an appointment, so just offering a choice of app is not enough. Clinics may need to post content with instructional pictures or videos to help those less familiar with technology.

Reaching out to patients can be done effectively in many ways: phone calls, virtual visits (via platforms such as FaceTime), the use of patient portals, text messaging. There has already been a significant jump in consumers reporting that they would be very excited to e-visit with a provider using a video service (9.12% in March 2020, up from 7.56% in December 2019), and preferences for being treated at home have increased among consumers.

How willing are consumers—and your patients—to interact via these different modes of communication? Going straight to the source, NRC Health surveyed consumers in April to find out how interested they were in using the different modalities.

Modality Very Interested Somewhat Interested
Phone call 33.8 36.8
Virtual visit 30.6 33.3
Patient-portal messaging 26.4 34.4
Text messaging 23.6 30.5

*Table represents national-level data with n=2004 responses. Numerical values represent the percentage of responses across all age cohorts.

While the traditional method of a phone call was the highest on the list, virtual visits were the next-best option—which means that virtual visits can not only increase safety during the pandemic, but also fulfill consumer preferences.

Telehealth has also become a way to mitigate the new visitation restrictions in place for healthcare appointments. Many health organizations are now only allowing patients within the facility—but using telehealth, family members can also participate (if the patient agrees to have them on the call, and HIPAA procedures are followed). This can be particularly useful in situations in which an elderly patient needs a caregiver to help ensure that they take their medications or follow physician advice, or in which a spouse wants their partner present for a visit with their doctor.

Telehealth also removes some of the obstacles inherent in physical healthcare facilities. Challenges such as where to find parking and where to go within a facility (which, even in the best of circumstances, some patients will invariably find confusing) are mitigated through telehealth, as is the often considerable distance between a patient’s home and the clinic. Once the pandemic has subsided, it’s anticipated that many patients will continue to use telehealth for these reasons.

With today’s modes of communication, it’s much easier to direct consumers to call their primary-care physician before showing up in an urgent-care department or emergency room. This helps resolve a decades-long challenge in healthcare to reduce the volumes of emergency-care patients who don’t need emergency care, by more intelligently routing them through the system. Telehealth is an important tool in this respect also, and may help clinics in the future improve their rates of on-time appointments (patients who can access their physician from home are less likely to show up late), manage patient volumes by efficiently scheduling appointments throughout the day, and reschedule cancelled in-office visits. It’s potentially a win-win for patient and provider alike.

When will patients feel ready to return to their providers after the pandemic wanes? Perhaps the answer is best sought in a redefinition of what it means to “go back to their providers.”  As the NRC Health research shows us, patients are already willing to seek more services in a virtual setting—it will simply require a shift in our thinking, and a new understanding of what it means to be “seen.”