A number of years ago I began to work in addictions, an area of practice that I now find extremely satisfying despite all of its inherent challenges. In comparison to family practice, with a practice roster of over 1,500 patients, I now look after less than 100 patients. Many of these have a high level of acuity as well as concurrent mental health issues and comorbid diseases such as HIV and Hepatitis C. While many patients struggle with their substance use issues on a daily basis, a significant number are stable and some have been in recovery for years. They are also very grateful for their recovery and continue to depend on their physicians, sponsors, support groups and counsellors to maintain their sobriety.
Patients with addiction issues have some unique challenges that make them very good candidates for remote care or telehealth. They may have to travel large distances to attend clinic appointments which is complicated by a need to depend on public transit. They frequently have financial issues as a result of their addictions, resulting in great difficulty if they need to purchase transit tickets. In addition, if working, they may be in remote locations, creating added difficulty in attending appointments consistently.
While telehealth is not appropriate for the majority of patients with addiction disorders, there is a specific patient population in which it is not only appropriate, but preferable to use telehealth services to provide care for these individuals. Telehealth is not a replacement for face-to-face care. It is an adjunctive tool that can be used very effectively to maintain continuity of care in situations in which it is difficult to see patients face-to-face.
In addiction treatment, developing a therapeutic alliance with a patient is a critical part of their recovery. Many of these individuals are victims of physical, mental or sexual abuse. They have been abandoned by friends and families and lack any structured support systems. It takes time to develop a therapeutic alliance upon which patients can depend, particularly when making difficult changes to behavior that are uncomfortable mentally as well as physically. Addiction patients are not good candidates for walk-in type care. They need this continuity in order to maintain their progress as well as their long-term sobriety.
Because mental health is so strongly associated with substance use, telehealth is an effective medium in order to support their care at a distance. Video conferencing allows the physician or counsellor to assess a patient in a way that cannot be done using the telephone. There are subtle body language cues that can be missed if one tries to depend purely on telephone support.
Our addiction medicine practice is fully EMR enabled. While this does not preclude other addiction practices from using telehealth to provide remote care to a subset of patients, it is certainly easier when one has computers in every room with videoconferencing capability.
One also needs a platform to provide teleconsultation services. I personally looked into a number of services, each of which has pros and cons. Polycom is an advanced teleconferencing system that is widely used in healthcare and within the provincial regional healthcare facilities, so using a Polycom system may make sense if you plan to provide teleconsultation services to patients in regional settings. After an extensive review I selected Medeo as my primary teleconhealth platform. Medeo provides a waiting room for patients, scheduling service, secure messaging and the ability to use desktops as well as mobile devices such as telephones or iPads. It is my opinion that Medeo is one of the leading telehealth platforms in Canada and one that could very effectively meet the needs of physicians who provide remote care to their patients.
Based upon my use of the platform, CanadianEMR will be promoting Medeo as a telehealth platform in 2015 for Canadian physicians.