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ISPOR: Matthew Reynolds of IQVIA Addresses Potential Overuse of Telehealth


Matthew Reynolds, PhD, vice president of real-world evidence at IQVIA, discusses his appreciation for telehealth and remote care, but feels over the next year or so we're going to be seeing more studies come out questioning if some telehealth is needed in certain areas. The discussion came from findings of a recent paper with the National Pharmaceutical Council on how COVID-19 affected real-world data and research.

Below is a brief Q&A of the interview with Reynolds. It has been edited for clarity.

Q: Do you see any potential for overuse of telehealth and remote care?

A: It's is interesting because, personally, I love the telehealth. I love the fact that I don't have to drive to a doctor's office and sit in there and kill two hours of my time for a five-minute assessment. That said, I think there's probably some care that can only be done for the patient at the doctor's office. There's some tests that you need to go in person for - the the lot of the the assessments that a clinician might want to make, whether that's body weight, visibly looking at a patient's body, collecting blood pressures, things like that need to be in person. I do think that telehealth is likely here to stay, especially for some therapeutic areas versus others. I think that we've seen a huge rise in the mental health usage of telehealth. Definitely others as well.

It's interesting because when we wrote this paper, one of the critical issues was the switch from typical medical assessments to telehealth. I took it upon myself to take a look at the literature and see that is it effective, where's it effective, who's effective, and the literature is still fairly mixed. I found a systematic review of reviews and of those about a quarter found that the telehealth was effective, a quarter found that there was some suggestive evidence, but it was unclear. The other half of it really had incomplete or non positive findings. That said, I still can't take much away because when I started digging through those studies, the types of clinicians using it, the type of therapies being used, what they call telemedicine, there are all of the different diseases being incorporated here. There was such heterogeneity. I don't know that there's an easy takeaway.

I do think that over the next year or so we're going to be seeing more and more studies come out to say, "does it work here?", "Does this type of teletherapy work?", "Does this teletherapy work better than this one?" You know, really understanding the factors associated with effective telehealth. I don't think we're there yet. I think it's starting to come out. Those insights I think will help to drive whether we're going to overuse it or potentially that we're not even using it enough.

Q: Has the pandemic-associated decline in utilization perhaps winnowed out some low-value care? If so, any particular tests or services? If not, why?

A: I have seen some papers here that have talked about low-value care really more tied to the overuse of services and procedures and such that maybe don't have a lot of benefit or cause results in patient dissatisfaction when compared to their utility in their benefit. It seems like things such as, potentially, some screenings or diagnostic tests, laboratory test, use of antibiotics, overuse of antibiotics; there are a list of things that I think are being evaluated now that I've seen in New England Journal Health Affairs, a number of these others where we have thought leaders talking about assessing this, but I have not seen results come through yet.

Given that I'm an epidemiologist and not someone who specializes in say managed care or even health economics per se, it's tough for me to answer that question, but I do expect that will be one benefit of this pandemic we likely will find out some of the services we really didn't need and or provided very low utility or marginal benefit. Don't know what those answers are yet. I gave a couple of examples, but those are those are all secondhand from what I've read from the experts in this field.

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