The urgency in keeping people out of medical offices where they could be exposed to the novel coronavirus has accelerated the use of medical appointments via video.

Before the pandemic, telehealth in North Carolina was most often promoted as a way to bring specialty medical care to rural counties. Now it’s being embraced throughout the state and by a broad range of specialties.

An initial visit with the Wake Endoscopy Center doesn’t necessarily require a patient with a digestive problem be in the same room as a doctor.

“Even in our field of gastroenterology, you can learn a lot from looking at a patient. Asking him to press his belly and looking at his expression — that tells us a lot,” said Dr. Neeraj Sachdeva, one of the managing partners at the endoscopy center.

The center’s appointments are drastically reduced, with the offices no longer doing routine procedures. But catching potentially serious health problems before they worsen is still a priority, Sachdeva said.

Telemedicine isn’t for all patients or conditions, Sachdeva said, but it’s a useful screening tool. About 20% to 30% of patients who have a video appointment need to come into the office.

“Telehealth has become the most practical way to keep our staff and patients safe,” he said.

Dr. Eileen Raynor, chief of the pediatric otolaryngology (ear, nose and throat) division at Duke University Health System, said in an email Monday that only patients with urgent needs are being seen in person. Other patients are being assessed to see if they can be seen in telehealth visits, or if they can wait until the COVID-19 crisis passes, she said.

In an interview last month, Raynor said she had seen mostly existing patients via video since the pandemic started.

“It’s really difficult to see new patients on video,” she said. Most people understand that having them avoid health care centers is meant to keep them safe.

“Things that aren’t super urgent, we’d rather us get past the crisis and see them then,” she said.

Physical therapy, a classic hands-on practice, has also found a use for video.

Jessica Grande, a physical therapist who works at Select Physical Therapy, offers patients one-on-one appointments through a platform that she described as similar to a conference call. The company began offering video-based appointments in response to the pandemic.

Grande described the sessions as “pretty typical.” She demonstrates every exercise and assesses patients’ movements.

“It’s been great, actually,” she said. “People seem to do really well with it. It’s good for the ones that don’t want to go out or can’t go out.”

MENTAL HEALTH TREATMENT BY VIDEO

Telepsychiatry had a toehold in North Carolina before the pandemic. Years ago, the state developed a program so people with mental health crises in hospital emergency departments could be assessed by psychiatrists via video.

In the last month, telepsychiatry has become more widely used.

“We have transformed our entire outpatient department to telepsychiatry so we can reach people anywhere across the state in ways we weren’t able to do before,” Dr. Samantha Meltzer-Brody, chair of the Psychiatry Department at the UNC School of Medicine, said in an interview with reporters Monday.

“It’s a huge opportunity for us to deliver mental health care in ways we haven’t had the chance to do before,” she said.

The department is using telemedicine for one-on-one appointments and plans to expand to group counseling for the general population, she said.

The private Holly Hill Hospital in Raleigh has begun offering Zoom therapy sessions for patients in an intensive outpatient program.

Alan Keel of Raleigh, who recently started using the video platform for his group sessions, said members of the group go to areas of their homes where they can talk privately.

Though he is eager for the group to meet in person, Keel said he’s comfortable with the video sessions.

“I think it’s a very good alternative, especially in these times,” he said. “People need to be able to continue to attend sessions, especially now.”

The Pines at Holly Hill, as the outpatient center is called, started offering therapy via video two weeks ago.

“Before COVID-19, we did everything face-to-face,” said Shandra Ross, an addiction therapist and mental health therapist at Holly Hill. The group therapy sessions started as an alternative to keep people safe, she said.

A rapport was built among participants before they moved to video sessions, she said. And each participant promises at every session they’ll protect one another’s privacy.

Hackers have been disrupting Zoom conferences, The Associated Press and other news outlets have reported. Ross said she is worried about hackers, but the hospital “has an agreement with Zoom that they’re going to try to protect us.”

“We’re going to hold Zoom accountable and hold ourselves accountable,” she said. “If there is an intrusion, we will make the necessary adjustments at that time.”

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INFUSIONS ARE STILL IN-PERSON

Some in-person care is harder to avoid.

Matt Angell, chief operating officer of Palmetto Infusion Services, said his clinic is taking temperatures of employees and staff, requiring staff members to wear masks, and making sure that patients stay far from one another.

Palmetto Infusion has one clinic in Raleigh. Most of the company’s patients have autoimmune disorders.

Patients are screened for COVID-19 symptoms when they make appointments and are asked if they’ve recently traveled from a coronavirus hotspot, including U.S. locations with significant outbreaks. They are screened again for symptoms when they arrive at clinics. Patients have been asked to wear their own cloth masks.

A person who had recently traveled to Detroit was asked self-quarantine for 14 days, Angell said.

Palmetto has seen a slight decrease in new patients, and upticks in cancellations and no-shows, Angell said.

“With the disorders we treat, if someone asks should the come in, they should,” he said. “The benefits outweigh the risks. With ulcerative colitis or Crohn’s, they may end up back in the hospital.”

This story was originally published April 13, 2020 at 2:46 PM with the headline "COVID-19 pandemic leads NC medical specialists to begin offering services via video."