Cara Rosner.- Cuando comenzó la pandemia, LaVita King de Bridgeport se preocupó por cómo continuaría viendo a su terapeuta de salud conductual y médico de atención primaria en Southwest Community Health Center. Vive lo suficientemente cerca para caminar hasta el centro de salud calificado por el gobierno federal de Estados Unidos, pero no se sentía cómoda al salir de su casa en esos primeros días, y mucho menos aventurarse en un consultorio médico. Pero ha podido acceder a la atención a través de conversaciones telefónicas y de video. “Para mí, ha sido un salvavidas, una bendición”, dijo King, de 69 años. “De lo contrario, no habría podido hablar con mi terapeuta de salud conductual durante todo este tiempo. El hecho de que pudiera hablar con ella por teléfono todas las semanas, y luego descubrimos una manera de poder vernos en video, es solo una bendición«.
La telesalud ha ayudado a conectar a los pacientes con los proveedores durante el año pasado. Ha sido particularmente crucial para mantener a los pacientes de centros de salud calificados a nivel federal (FQHC), muchos de los cuales son personas de color y tienen Medicaid, conectados a la atención médica durante la pandemia. Pero si bien la telesalud ha traído algunos beneficios de atención médica y ha mantenido a los que ya reciben servicios conectados con sus proveedores, los informes nacionales de la Fundación Robert Wood Johnson y Health Affairs muestran que la tecnología ha hecho poco para llegar a nuevos pacientes, y aquellos con un dominio limitado del inglés tenían bajos tasas de uso de telesalud. Los FQHC son proveedores de atención médica comunitarios que reciben fondos federales para brindar servicios de atención primaria en áreas desatendidas. Deben cumplir con un estricto conjunto de requisitos, incluida la prestación de atención en una escala de tarifas variable basada en la capacidad de pago y operar bajo una junta directiva que incluye a los pacientes. Según Ken Lalime, director ejecutivo de la Asociación de Centros de Salud Comunitarios de Connecticut, el 62% de los pacientes de FQHC en Connecticut tienen Medicaid, el 10% tienen Medicare y el 15% no tienen seguro. La mayoría, alrededor del 90%, tiene ingresos que duplican el nivel federal de pobreza, y más de la mitad no habla inglés como primer idioma. Hay 17 FQHC en Connecticut. Los FQHC vieron caer su número de visitas de pacientes tan pronto como golpeó la pandemia de COVID-19, dijo Lalime. Los proveedores se preguntaban cómo llegarían a sus pacientes en riesgo y les brindarían la atención que necesitaban. La telesalud surgió rápidamente como la respuesta.
El 10 de marzo de 2020, el gobernador Ned Lamont emitió una orden ejecutiva que, entre otras cosas, permitió a Medicaid cubrir las visitas de telesalud. El 10 de mayo de 2021, promulgó una ley que extiende esa disposición por otros dos años. “La telesalud lo significó todo para las personas que tuvieron acceso a la atención durante la pandemia”, dijo Jill Zorn, oficial senior de políticas de Universal Health Care Foundation de Connecticut. “Desde la perspectiva del cuidado de la salud, no poder ver a su médico fue un problema real. Que [las aseguradoras, incluido Medicaid] pagaran por telesalud fue enorme. Si algo bueno salió de la pandemia, este es uno de ellos«. Cuando comenzaron los cierres de COVID, los FQHC en el estado vieron caer las visitas de pacientes hasta en un 80%. Una vez que el estado permitió la telesalud, algunos centros realizaron hasta el 80% de sus visitas de esa manera, y durante el año pasado aproximadamente, alrededor del 50% de todas las visitas de FQHC han sido visitas de telesalud, dijo Lalime. La cantidad de visitas de telesalud está comenzando a disminuir ahora, dijo, ya que los pacientes se sienten más cómodos programando visitas en persona.
‘Un cambio de juego’, pero no para todos
A través de telesalud, King ha continuado con su plan de atención, ha obtenido referencias para cualquier prueba o exploración que necesite y se ha asegurado de que sus recetas estén actualizadas. «Todas las cosas que necesitaba haber hecho porque tengo acceso a mis proveedores a través de la telemedicina, he podido hacer esas cosas«, dijo. El personal del Southwest Community Health Center en Bridgeport llevaba mucho tiempo interesado en la telesalud, pero nunca antes era factible porque Medicaid no cubriría los gastos, dijo la presidenta y directora ejecutiva del centro, Mollie Melbourne. “La telesalud fue un cambio de juego para nosotros. Realmente nos ayudó a mantener esa conexión con nuestros pacientes”, dijo Melbourne. Añadió que era fundamental para los pacientes que recibían servicios de salud mental o conductual y para aquellos con enfermedades crónicas. “La tecnología fue un desafío [desde el principio], pero el concepto de telemedicina, cayó directamente. Parece que a los pacientes les encanta, especialmente para la salud del comportamiento”, dijo Melbourne. «Y una vez que superamos los obstáculos tecnológicos, los proveedores realmente lo disfrutan». La telesalud elimina varias barreras para la atención, incluida la necesidad de transporte, dijo Joanne Borduas, directora ejecutiva de Community Health & Wellness Center , que tiene ubicaciones en Torrington y Winsted. “No tenemos transporte público en absoluto” en el área, dijo. “Es un desafío tal como es, sin una pandemia, tratar de que nuestros pacientes regresen y se mantengan conectados con ellos. La capacidad de mantenerse conectado con ellos es fundamental para su salud y bienestar”, dijo. Sin la telesalud, dijo Borduas, “probablemente hubiéramos visto un enorme aumento en los resultados adversos. Lo que eso habría causado es este ciclo a lo largo de la pandemia de [pacientes] que tienen sus necesidades satisfechas en la sala de emergencias. Estábamos muy contentos de haber podido utilizar la telesalud«. La telesalud telefónica, en particular, ha sido un salvavidas para muchos, dijo.
“No todos nuestros pacientes tienen la capacidad o el dinero para comprar computadoras, por lo que la capacidad de realizar telemedicina por video fue un desafío”, dijo. “El componente de solo teléfono fue realmente un salvavidas para muchos de nuestros pacientes; se convirtió en un componente tan grande«. La telesalud ha traído varios beneficios, pero también nuevos desafíos. «Definitivamente hubo algunos dolores de crecimiento«, dijo Lalime. “Para ponerlo en marcha, fue necesaria la educación del paciente y la educación del sistema. Connecticut respondió con bastante rapidez a esto, pero no fue instantáneo. Tomó algún tiempo.« La Asociación de Centros de Salud Comunitarios está estudiando el impacto de la telesalud y qué tan bien funcionó durante la pandemia, dijo. Para mas información Fuente: C-HIT.
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