Telemedicine encounters differ from being in the same room with patients —in surprising ways.

By Sree Roy

The need for an unexpected veterinary appointment for our family dog could not have come at a worse time. Our 8-year-old Tibetan terrier mix had just gotten bit by a neighbor’s dog who had momentarily gotten loose and apparently wanted justice for the many times our dog barked at him during our daily walks.

Though the internet was full of cautionary tales of dogs who seemed OK after a bite but later succumbed to their internal injuries, I didn’t know if I could find the time or energy to drive our dog to his vet. At 8 months pregnant, I’d already been struggling to make up the work hours that I’d been using to take care of my own healthcare appointments, not to mention my frustration over their associated costs (such as a $10/hour parking lot).

I texted the vet with a brief summary, and he replied: “Have you downloaded my airVet app? We can chat real-time with video if you want me to see him.” As it turns out, my vet had just launched a veterinary telemedicine platform available for free download on my iPhone. I’m not sure I’ve ever felt more relieved.

Telemedicine may now be at a tipping point, particularly in sleep medicine. In July, a subsidiary of the American Academy of Sleep Medicine (AASM) unveiled a partnership to launch an online sleep care platform for self-pay patients. The Sleep Care platform, a partnership between Welltrinsic (AASM subsidiary), The CPAP Shop parent Agile Medical, and sleep diagnostics company CleveMed, launches with a focus on obstructive sleep apnea (OSA) in Ohio only but plans to expand to evaluating all sleep disorders and to being available nationwide.1

And, from a research perspective, new information is being released regularly about who telemedicine works best for and why. For example, a randomized controlled study found that the proportion of nights with CPAP use of an hour or more and the daily hours of use at 6 months didn’t differ between a telemedicine group and a control group, but the telemedicine intervention did lead to increased usage in a subgroup of patients with mild OSA, per a post-hoc analysis.2 For those patients, perhaps they made the same calculation I made with my dog’s vet visit: Is it worth the time and effort to attend an in-person visit, when I suspect the outcome will be OK without it?

That said, several aspects of our dog’s virtual visit were surprisingly different than our in-person experiences.

I was more open with the vet than I would have been in person. That’s likely because I feel rushed when I notice other patients waiting for their exams.

There’s no nurse (or vet tech) to triage and take vitals. This is a downside for practitioners. But the patient can complete many of their own vitals with you supervising via webcam.

Self-pay is likely an option, even for patients who use insurance for standard visits. Our vet charges less for virtual visits ($30 versus $70+), but I would have paid $100 to not leave my house that day—and I’m typically cost-conscious.

If you’re previously dismissed telemedicine as not for your practice, now is a good time to reconsider.

And, in case you’re wondering, homecare was all our dog needed. He remains as healthy as ever—including not learning any lessons about the risks of barking at dogs who are bigger than him.

Sree Roy is editor of Sleep Review.

References
1. Sleep Telemedicine Service for Self-pay Patients to Launch as AASM Subsidiary, CleveMed, CPAP Shop Parent Partnership. 2 July 2019. Sleep Review. Available at www.sleepreviewmag.com/sleep-telemedicine-service-sleepcare
2. Schoch OD, Baty F, Boesch M, et al. Telemedicine for continuous positive airway pressure in sleep apnea: A randomized, controlled study. Ann Am Thorac Soc. 2019 Jul 16. [Epub ahead of print]