Telehealth and the Therapeutic Alliance
Almost overnight, COVID-19 has transformed the delivery of healthcare by ushering in the use of telehealth. By 2021, telehealth is expected to grow in the U.S by 27.5%, reaching $9.35 billion, according to a survey managed by Jackson Healthcare. This transition has eased the implementation of social distancing to help “flatten the curve” of COVID-19, reducing the burden on our healthcare system. Telehealth has also been successful in reducing the time and geographical obstacles faced by many in our country in receiving care, however some may be skeptical about its effectiveness when you are unable to be “physically” evaluated by your provider. Here are five reasons that may make you reconsider. (1)
Telehealth can improve patient-to-provider communication. Two minutes of listening time is sufficient for nearly 80% of patients to explain the reason for their consult. (2) However, it takes on average only 11 seconds for a provider to interrupt them. To make matters worse, only one-third of doctors even provide adequate time for their patient to describe their situation. (3) With the implementation of telehealth, this “impersonal” nature of communication amplifies the need of providers to focus on advanced communication and listening techniques to not only assess their patients, but to build trust with them.
Telehealth can still create a strong therapeutic alliance. A therapeutic alliance is the working relationship and trust that is developed between a provider and patient. A strong therapeutic alliance can be created with patient-centered care, in which the provider acts as an educator and facilitator to patients to achieve their goals. A variety of communication factors (interaction style, verbal cues, non-verbal cues) have been found to contribute to the strength of this bond. (4) As studies overwhelming show, the therapeutic alliance is associated with improved outcomes in treating low back pain and other forms of chronic musculoskeletal pain; maintaining this relationship is crucial to care. Fortunately, studies examining the effectiveness of telehealth have found clients rate the bond with and presence of their provider to be equally as strong as in-person settings. (5)
Telehealth can more effectively triage patient’s needs. Telehealth can provide safer care. As the world must confront the likelihood that COVID-19 will be with us for some time, maintaining degrees of social distancing will be crucial in managing its spread. Virtual visits allow providers to triage patients and their needs without increasing the odds of transmission within a clinic. (1) As there is a wealth of literature showing the effectiveness of exercise alone in treating musculoskeletal conditions, telehealth can be used by physical therapists to provide effective treatment and then co-implemented with in face-to-face visits if manual therapies are needed. (6)
Telehealth provides a source of more accurate information than the internet and apps alone. In the age of technology, many consumers rely on health information provided by “trustworthy-deemed” websites run by hospitals, universities, professional associations, and government agencies. However, researchers examining information related to low back pain on these non-commercial and freely accessible sites found they demonstrated low credibility standards, provided mostly inaccurate information, and lacked comprehensiveness of the topics. (7) Telehealth provides patients the opportunity to have one-on-one individualized consults with their trusted providers who can tailor this information to each person’s specific needs.
Patients are satisfied with telehealth. Technology may seem like a frustrating barrier to overcome for some. Researchers and users together have identified over 30 barriers or frustrations that patients have when using telehealth. However, they concluded these barriers occurred less than 4% of the time, and patients were satisfied with decreased commuting time, ease of schedule, less wait time, and lower costs. (1, 8) In turn, these benefits are correlated with improved communication, more efficient care, improved medication adherence, fewer missed visits, and decreased readmission, giving providers a reason to smile, too. (9)
Still not sure? Read more with the American Physical Therapy Association’s article, 6 Reasons to Consider Telehealth Physical Therapy.
References:
Scott Kruse C, Karem P, Shifflett K, Vegi L, Ravi K, Brooks M. Evaluating barriers to adopting telemedicine worldwide: A systematic review. J Telemed Telecare. 2018;24(1):4‐12.
Langewitz W, Denz M, Keller A, Kiss A, Rüttimann S, Wössmer B. Spontaneous talking time at start of consultation in outpatient clinic: cohort study. BMJ. 2002;325(7366):682‐683.
Singh Ospina, N. et al (2018). Eliciting the Patient’s Agenda- Secondary Analysis of Recorded Clinical Encounters, Journal of General Internal Medicine DOI: 10.1007/s11606-018-4540-5
Pinto RZ, Ferreira ML, Oliveira VC, et al. Patient-centred communication is associated with positive therapeutic alliance: a systematic review. J Physiother. 2012;58(2):77‐87.
Simpson, S.G. and Reid, C.L. (2014), Alliance in videoconferencing psychotherapy. Aust J Rural Health, 22: 280-299.
Farr M, Banks J, Edwards HB, et alImplementing online consultations in primary care: a mixed-method evaluation extending normalisation process theory through service co-productionBMJ Open 2018;8:e019966. doi: 10.1136/bmjopen-2017-019966.
Ferreira G, Traeger AC, Machado G, O'Keeffe M, Maher CG. Credibility, Accuracy, and Comprehensiveness of Internet-Based Information About Low Back Pain: A Systematic Review. J Med Internet Res. 2019;21(5)
Cottrell MA, Hill AJ, O'Leary SP, Raymer ME, Russell TG. Patients are willing to use telehealth for the multidisciplinary management of chronic musculoskeletal conditions: A cross-sectional survey. J Telemed Telecare. 2018;24(7):445‐452.
Kruse CS, Krowski N, Rodriguez B, Tran L, Vela J, Brooks M. Telehealth and patient satisfaction: a systematic review and narrative analysis. BMJ Open. 2017;7(8):e016242. Published 2017 Aug 3. doi:10.1136/bmjopen-2017-016242