Provider Perceptions Toward Telemedicine and Sensitive Exams: Impact of Conducting Sensitive Exams online and Sharing and Uploading Sensitive Media

Research Article

J Fam Med. J Fam Med. 2024; 11(5): 1368.

Provider Perceptions Toward Telemedicine and Sensitive Exams: Impact of Conducting Sensitive Exams online and Sharing and Uploading Sensitive Media

Lee E¹; Moran RM²*; Heavey L³

1Assistant Professor, Department of Family Medicine Loyola University Medical Center, USA

2Department of Family Medicine Loyola University Medical Center, USA

3School of Public Health Loyola University, USA

*Corresponding author: Moran RM Department of Family Medicine, Loyola University Medical Center, 3231 S. Euclid Avenue Floor 5 Berwyn, IL 60402, USA. Tel: 708-783-2000, 708-783-3656; Email: [email protected]

Received: May 07, 2024 Accepted: May 31, 2024 Published: June 07, 2024

Abstract

Background: Telemedicine emerged as vital resource for patients to access medical care during the COVID 19 pandemic. This rapid adoption revealed many challenges of which one is the sensitive exam.

Objective: This study’s purpose is to determine the practice patterns of providers using telehealth services to complete sensitive exams. From these results suggestions for what future best practices may be determined.

Design: A mass survey regarding patient comfort with chaperone use and telehealth and with casual patient behaviors and telehealth was sent out to invited participants. Participants included providers at the Primary Care, Family Medicine, and Internal Medicine departments at Loyola University Medical Center.

Results: 42 participants responded. These respondents were primarily white female physicians. Overall clinicians did not feel comfortable performing any physical exam via telehealth. They preferred to defer sensitive exam and review of sensitive materials to in person encounters. Respondents also viewed themselves as conservative while rating most interactions with patients as casual.

Conclusion: In general providers feel less comfortable performing any exam virtually and that telehealth increases discomfort with interacting with any sensitive material. Further research into its use and development of standards particularly regarding the sensitive exam

Keywords: Telehealth; Sensitive Exams; Attitudes; COVID 19

Background

Telehealth has been a part of healthcare since about 1996 [1]. First utilized by the VA for consultations in remote areas. Its offer of convenience, improved access and increased patient satisfaction has been promising to transform healthcare. It was not until computers and smartphones began being a part of daily life that this promise began to become a reality [1-2]. Yet still in a national survey in 2014, only 15% of family physicians reported using telemedicine [3]. It was not until the COVID-19 pandemic that there was widespread adoption of telehealth practices [4]. Several studies show that telemedicine is cost effective while maintaining positive outcomes [5-7]. While providers have adopted and adapted to telehealth professional organizations have been lagging behind in setting standards and guidelines for this medium [8].

Some institutions, like the Society of Teachers of Family Medicine, have created Telemedicine Modules to help teach providers about telemedicine. And resources have been created to help providers feel more comfortable performing various physical exams via telemedicine. Some exams can be transitioned to a telemedicine (such as orthopedics) [9]. One aspect of physical exam that presents a unique challenge to the telehealth model and to education of telehealth is sensitive exams. Exams of the breast, genitals, and rectum have always presented challenging to providers from a patient comfort and medicolegal perspective. Overtime an emphasis has been placed on chaperoning these exams. The chaperone offers some measure of comfort to the patient and some legal protection to the provider [10-11]. While this has become somewhat standard in the office, this is not always feasible on telehealth [12]. The VA in their Telehealth Manual state that for gender specific procedures and exams a female chaperone is present, but this was prior to the pandemic, when telemedicine visits were mainly used for consultations of patients who were at a VA hospital institution, rather than patients being at home, work, or in public [13]. This has left providers to craft their own practice in a relatively undifferentiated time.

Patients on the other hand like several things about a telemedicine visit convenience, lack of travel/time spent in the visit, but also have their own concerns, such as difficulty surrounding physical exams [1]. Similarly, telemedicine also allows for asynchronous communication with patients. Some patients find this beneficial because especially for dermatologic conditions they can take a photo and upload it to their provider’s telemedicine web portal. Medical-legally most web portals have a statement when patients sign up regarding anything written/uploaded via the web portal will be in the patient’s chart. But at this time, there does not exist a protocol for how the provider should handle photos of sensitive areas, nor is their guidance for patient’s on how to upload images to prepare providers for what they will be seeing.

It is the aim of this study to determine the practice patterns of providers using telehealth services to complete sensitive exams in hopes of making suggestions for best practice.

Methods

A voluntary survey which included questions regarding patient comfort with chaperone use and telehealth and with casual patient behaviors and telehealth was sent out to invited participants via email using an online survey platform. The survey-maintained anonymity, but the email contained information to consent participants. After reading the email, participants consented to participate by clicking the survey link, and those who did not consent did not complete the survey.

Invited participants included Loyola Departments of Primary Care, Family Medicine, and Internal Medicine (n of 345 IM=253, PC = 92). After about 1 month, due to low response rate, the email with survey link was sent out again. Any Loyola physician, physician’s assistant, or nurse practitioner with internet access and an email in one of the three listed departments were eligible to participate.

Analysis included using SAS Studio for data management, descriptive, and analytical statistics. The frequency counts for all descriptive data were obtained. ANOVA tests were used to determine the relationship between provider comfort level conducting the telehealth visits when the situation included a sensitive exam. All tests were calculated at the alpha=.05 level, in conjunction with estimated 95% confidence intervals.

The research study was approved by the Loyola University Chicago Health Sciences Campus Institutional Review Board (IRB).

Results

In total 42 of the 482 providers comprising Loyola’s Departments of Primary Care, Family Medicine, and Internal Medicine completed the survey. The response rate was 8.7%. Overall, respondents to the survey identified themselves as physicians (85.71%). The majority were in practice for at least 10 years (61.91%). Table 1.

Citation:Lee E, Moran RM, Heavey L. Provider Perceptions Toward Telemedicine and Sensitive Exams: Impact of Conducting Sensitive Exams online and Sharing and Uploading Sensitive Media. J Fam Med. J Fam Med. 2024; 11(5): 1368.