In today’s dynamic healthcare landscape, asynchronous (“async”) care has revolutionized how patients and providers connect, enabling clinical communication without real-time interaction. As a physician who has experienced the transformative power of async care firsthand, I am passionate about its potential to bridge the gap in healthcare access and enhance equity. In this article, I will delve into the concept of async care, highlighting its advantages and showcasing how it contributes to a more equitable healthcare delivery system.

Understanding asynchronous care

Async care can happen in various ways, and while it’s not a new model of care delivery, it has become increasingly popular in recent years, especially since the start of the Covid-19 pandemic. Some examples include a patient sharing a medical concern with a provider via secure message, the provider then reviewing information and sharing recommendations with the patient. Or, providers can share clinical cases with specialists, who offer advice that can then be shared with patients. Patients can also access async care by completing online questionnaires or forms, which are then reviewed by physicians or processed through algorithms to provide personalized recommendations.

Expanding access to underserved communities

One significant advantage of asynchronous care is its ability to extend healthcare access to traditionally underserved communities. While traditional synchronous telehealth often requires live visits, asynchronous care can be done anytime, anywhere, and with simpler technologies like a cellular connection. Unlike synchronous visits, no broadband is needed for a smooth telehealth experience. This is particularly crucial as millions of Americans, especially people of color and those living in rural areas, lack access to broadband internet.

Data from the Covid-19 pandemic challenges common telehealth myths by revealing that people of color, patients requiring language translation, and older Americans were equally (if not more) likely to utilize telehealth for care. However, these groups demonstrated a lower preference for video visits and instead relied heavily on asynchronous modes of communication, such as messaging, text, and audio-only telehealth visits. These findings emphasize the importance of asynchronous care in addressing the needs and preferences of diverse patient populations help overcome significant barriers to access.

Overcoming geographical barriers

Asynchronous care also improves equitable access to specialty or expert physicians, who are often located further away from patients and might have long wait times for visits. Asynchronous care can greatly benefit individuals who lack reliable transportation, struggle to take time off work for lengthy specialist visits, or face challenges in finding time and space for live video visits at their workplace.

By embracing asynchronous care, we can help individuals maintain their health conveniently, meeting them where they are and providing the highest quality of expert care.

Leveraging physician expertise

I’ve been involved in asynchronous care in some fashion since becoming a physician. As resident doctors, my team would round on patients in the hospital, gather their lab results and vital signs, and ask about their symptoms. We would then present these cases to our attending physicians, who would ultimately formulate and sign off on the plan of care. This was already a simplistic form of asynchronous care without the use of technology. Another very common example of asynchronous care is the “curbside consult”. This is when an endocrinologist like myself calls my colleague, the gastroenterologist, so that “specialist” advice is obtained without any inconvenience or extra cost to the patient. These “curbside” calls have always been a tool that physicians have used to access the brain trust of our peers.

As doctors, we each have our own areas of expertise. However, even as generalists, we come upon clinical cases that are unfamiliar or that we have only dealt with on rare occasions. While online resources and the medical literature can offer support, the best answers come from a clinician who deals with that case daily. Asynchronous care allows us to access the expertise patients need for safe and effective treatment in a much more convenient, affordable, and efficient way.

Safety and effectiveness

People often ask if reviewing information collected and summarized by another provider, or reading a message from a patient is enough for a doctor to make a safe clinical recommendation. Well, the answer is, “It depends”. This is where a doctor’s expertise really comes into play. A clinician requesting a specialist consult must have a good understanding of what information is important and relevant for the specialist to recommend.

On the flip side, the physician receiving the consult must be aware of crucial information that may have not been shared, which could be critical for making a safe recommendation.

As physicians, we also need to recognize when an in-person or live video visit is necessary and when we need additional information from our patients who are seeking asynchronous care.

The data on asynchronous care is very positive. Studies show that asynchronous visits between patients and providers produce improved or equivalent outcomes for chronic conditions compared to standard in-person care. In the case of diabetes management, e-consults between pharmacists and patients with above-target glucose levels resulted in a remarkable three-point drop in hemoglobin A1c at 6 months.

Asynchronous consults between physicians and specialists have been extensively studied, including at the hospital where I completed my medical training. Endocrinology is one of the top specialties receiving e-consults (an asynchronous physician-to-specialist consultation). Over the years, I have completed thousands of e-consults for my primary care colleagues. Studies show that e-consults reduced the time needed to complete the workup for certain medical concerns like hematuria (blood in the urine) and increased the use of appropriate medications for conditions such as osteoporosis. Primary care physicians and patients also report high satisfaction levels when asynchronous consults are available.

Conclusion:

Asynchronous care represents a transformative approach in healthcare, enabling equitable access to quality care while overcoming geographical and technological barriers. Its positive impact on patient outcomes and satisfaction and its ability to connect providers and expand expertise make it an invaluable tool in modern healthcare delivery. Embracing async care allows us to revolutionize healthcare, ensuring that every individual, regardless of their circumstances, can receive the care they need when and where they need it.

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