Virtual doctor visits and care gaining popularity


By Camri Nelson - cnelson@limanews.com



Mail-order pharmacies are often seen as a convenient alternative to going to a local brick-and-mortar pharmacy. There is debate as to which model provides the best service to patients. Photo illustration by Craig J. Orosz | The Lima News

Mail-order pharmacies are often seen as a convenient alternative to going to a local brick-and-mortar pharmacy. There is debate as to which model provides the best service to patients. Photo illustration by Craig J. Orosz | The Lima News


LIMA — Since the 1950s, telemedicine services has allowed patients to communicate with doctors and receive medication without leaving their homes. While some medical professionals believe the service is convenient, others think it could be a hindrance.

Within the last couple of years, telemedicine services like NURX, HeyDoctor and PlushCare have changed the way patients receive medical care.

Instead of waiting at the doctor’s office, patients can now schedule video chats with their doctor and get their medication prescribed through a laptop or mobile device.

Telemedicine services

Dr. Edward Levine, medical director of the virtual health program at The Ohio State University Wexner Medical Center, began his journey with telemedicine in 1995. Since then, Levine has used telemedicine services to prescribe medication and communicate with inmates in institutions within the Ohio Department of Rehabilitation and Correction. The inmates go the nursing station located in the prison where they would Skype with Levine, and he would write a prescription based on their symptoms.

The Ohio State University Wexner Medical Center currently provides telemedicine care for about 1,400 to 1,500 prisoners a year.

“The benefits are safety,” said Levine. “The prisoners stay in the prison, and it’s also cost saving because the prison doesn’t have to pay guards and transportation to transport them here.”

Prisoners are not the only patients to whom the medical center provides this type of care. The medical center offers various other telemedicine services for gastroenterology, transplant and cancer patients through its virtual health department.

“It’s a convenience for patients because some of them don’t like to come and see the doctor,” said Levine. “They have to take off of work. They have to drive and so fourth. They would just prefer to do things virtually in the privacy of their own home.”

In 2015 NURX, a telemedicine service that specializes in birth control and PrEP HIV prevention medication, launched as a way to make birth control more accessible and more convenient.

“It can be timeconsuming to go to a doctor and then go see a doctor and then go wait in line at the pharmacy,” said Allison Berry, NURX spokeswoman. “Nearly 20 million women living in the U.S. don’t have access to clinics that can provide really good contraceptive care. We certainly want to be available to the person who is really busy but we also want to take care of the single mother of three who is constrained on time.”

The first step to obtaining birth control on NURX is to fill out a medical history form that includes a patient’s age, weight, blood pressure, whether they smoke, and other prescriptions being used.

The patient is also asked to verify their identity by uploading a selfie and form of identification.

Once the information is submitted, a state-certified medical doctor or nurse practitioner will review it to determine whether the medication is appropriate for the patient. NURX covers patients in 20 states.

“All of the statewide doctors that we work with use the same exact standards, practices and conduct that is required in person healthcare services,” said Berry. “State by state, there are requirements on how exactly we can interact with the users. So we just make sure that in any state that we are operating in we are ensuring those regulations.”

If approved, patients could choose from over 50 birth control brands for the pill and NuvaRing and the patch.

“One of the things that is most important for us is to make sure that we are offering these really critical health services to people regardless of their insurance status,” said Berry. “We have a lot of generic options for people who do not have health insurance.”

Birth control is either free or the cost of a copay for insured patients.

Once the medication has been purchased, it will be sent to the patient’s home address. If the patient has any further medical questions, they can reach out to the doctor or nurse practitioner through a messenger.

There’s no standard delivery time, but once the medication needs to be refilled, patients can utilize on-demand options to refill the prescription.

Patients who are looking to get PrEP can also use a provided home test kit where they can take all the results from home through a prick on the finger, which helps the doctor determine if they are a viable patient.

“We want to make sure that the process that our users are going through with NURX is safe and secure,” said Berry. “We certainly want to make sure that they are getting the prescriptions that they need, but that the process is safe and secure, as well.”

Preparing for the future

Because most doctors are not trained on how to care for patients through telemedicine, Levine said at Ohio State University they are working on a training for medical students to familiarize them with that practice. They also train their interns, residents and fellows on telemedicine.

Levine also said that some telemedicine services will be provided at Mercy Health- St. Rita’s Medical Center and Lima Memorial Health Systems.

Ultimately Levine believes that telemedicine will help decrease emergency room utilization and will make doctor visits more convenient for patients.

“There is a lot going on and it’s a rapidly changing field,” said Levine. “I just think that you’re going to see more and more of it and it’s going to really blossom within in the next several years.”

Downside of telemedicine

Kyle Miller, pharmacy supervisor of Mercy Health-St. Rita’s Medical Center Outpatient Pharmacy, believes that telemedicine services that utilize mail order prescriptions could be a hindrance to local pharmacies.

“The downside is that patients can’t use their local pharmacy if they are using that today,” said Miller. “That pharmacist may not have all of that information available to make sure that there isn’t any drug interactions or verify that the medication can be taken with the other medications that the patient has.”

The FDA shows that only 3 percent of the online pharmacies they reviewed were legitimate and abide by standard pharmacy practices and laws, said Miller.

“That’s another concern,” said Miller. “Is it a legitimate pharmacy and are you getting FDA-approved medication? Are they going to protect your privacy and keep your information confidential?”

Miller said that mail-ordered prescriptions like Express Scripts are typically legitimate.

Over the last 10 years, Miller said, pharmacy jobs have been cut to combat increasing costs, but he also believes that electronic prescriptions also contributes to the lack of jobs.

“[Mail-ordered prescriptions] have been and will be responsible for fewer jobs in the community because there will not be as many prescriptions like there were before mail order,” said Miller.

Miller suggest that patients verify the legitimacy of the pharmacies by going to pharmacy.ohio.gov.

“They would have to have a license in that patient’s state in order to be legitimate and abide by the laws associated with obtaining FDA-approved and reliable medication and dispensing,” said Miller.

Levine admits that there are limitations with telemedicine, but trained doctors know that the service cannot be used in all situations.

“Most of the decision making is done by taking the history [of the patient], and if there is a concern for something more serious, then this is not the appropriate utilization,” said Levine. “Obviously, there is no expectation that you are taking care of everything virtually. There will still be a need for emergency rooms.”

Mail-order pharmacies are often seen as a convenient alternative to going to a local brick-and-mortar pharmacy. There is debate as to which model provides the best service to patients. Photo illustration by Craig J. Orosz | The Lima News
https://www.limaohio.com/wp-content/uploads/sites/54/2018/10/web1_Mail-order-prescription01co.jpgMail-order pharmacies are often seen as a convenient alternative to going to a local brick-and-mortar pharmacy. There is debate as to which model provides the best service to patients. Photo illustration by Craig J. Orosz | The Lima News

By Camri Nelson

cnelson@limanews.com

Reach Camri Nelson at 567-242-0456 or on Twitter @CamriNews.

Reach Camri Nelson at 567-242-0456 or on Twitter @CamriNews.

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