Social distancing required to mitigate the spread of the SARS-CoV-2 virus makes providing health care via phone calls and video chats not just a convenient option but an imperative in 2020. The pandemic strengthened telehealth’s toehold in many fields, and nurses at the forefront of virtual visits believe it will remain as a permanent part of the “new normal.”
“I think telemedicine is here to stay, and this will change the way we practice in mental health,” said Cizik School of Nursing at UTHealth Assistant Professor Kelly Kearney, DNP, PMHNP-BC. “Health care providers who weren’t using the telehealth platform previously now see the benefits and the necessity of adding this to their practice as another avenue for increasing access to needed health care visits.”
Kearney is the school’s psychiatric nurse practitioner program track coordinator. She conducted a couple of sessions a week with patients prior to COVID-19, then converted her entire caseload to telehealth. Not only did it enable her to “keep the doors open,” it allowed patients to continue their counseling and treatment without interruption or risk of infection.
“Quite a few of my patients were afraid if they went outside, they would contract the virus,” Kearney said. A few did test positive, some lost their jobs, and isolation increased risks for those who suffer from depression and live alone.
Associate Professor Rebecca Casarez, PhD, PMHCNS-BC, provides counseling at the UT Health Services clinic. She also increased the use of virtual appointments, and she is glad the clinic has given patients the option of in-person, telephonic, or video sessions throughout the crisis.
“There are some people who really want to do online visits, and there are others who really want to meet in person because they miss that personal interaction since so many other things are not in person,” Casarez said.
In the long term, telehealth will remain an important tool for mental health care providers, Kearney predicts, not only because it facilitates treatment of patients in remote, rural areas, but because it makes counseling more convenient for those who would otherwise have to miss work or school for appointments. The cancellation rate for virtual appointments has been very low, she noted.
Darrine Abouchelleih, RD, a nutritionist at UT Health Services, also noticed fewer cancellations when she shifted to virtual nutrition and diabetes prevention classes and counseling. In addition to working with individual patients, Abouchelleih conducts several group sessions per week as part of the Centers for Disease Control and Prevention’s National Diabetes Prevention Program. She began hosting them via videoconference in March.
“I can’t tell you it changed what I do significantly,” she said. “But I do love to see my patients in person. We like to do activities during our classes like marching in place or walking around the building. It’s harder to do that virtually.”
Homebound routines and stress related to the pandemic have made healthy eating and exercise more challenging for most of Abouchelleih’s patients, but a few said they were glad to be able to work from home and take daily walks around their neighborhoods.
The applications for telehealth may be more limited in the primary care setting, but they are no less vital when patients are being encouraged to stay at home as much as they can.
The pandemic did not put a halt to in-person care at UT Health Services, Cizik School of Nursing’s nurse-led clinic. Some health care needs, like lab work or examinations for acute conditions, simply can’t be done remotely. But phone calls to check in on patients with chronic diseases and to refill prescriptions have been crucial during the pandemic, and videoconferencing can work well for conditions that require visual examinations only, like skin rashes, said Angela Rutherford, MSN, ANP-C, nurse practitioner with UT Health Services.
“For me, the bottom line is we’ve got to take care of the patient, even if it’s just maintaining care during the pandemic,” she said.
Assistant Professor Mitzy Kobeissi, DNP, FNP-C, is a telehealth veteran who operates her own concierge practice on the weekends. Her average patient is a stay-at-home, suburban mom. She frequently made house calls when she began her practice, but these days she sees most patients via video visits.
Kobeissi would normally handle colds, flu, and sinus and ear infections, but because those conditions share symptoms with COVID-19, she now refers such patients for in-person treatment in case they need a higher level of care. Treating minor health concerns for patients via telehealth helps take the pressure off of emergency departments, she noted.
Her experience following Hurricane Harvey proves the value of telehealth services – and of being prepared to ramp them up in a crisis.
“I was so busy after Harvey because people couldn’t get to their health care providers,” she said. “I find that in times of disaster, I become a go-to because I’m already equipped to do everything online.”
Kobeissi is sharing her expertise at Cizik School of Nursing. In the summer of 2019, she taught doctoral students how to set up a telehealth clinic, and this fall she is teaching telehealth principles in family nurse practitioner clinical courses.
“We are teaching them how to conduct a proper video visit and how to make a connection with the patient through the screen,” she said.
Sherri Deatherage Green