Dr. Gauri Behari is an Endocrinologist and author. She is the Director of Medicine Telehealth at the Veterans Affairs Hospital in Phoenix, Arizona. She also serves as a clinical assistant professor of Endocrinology at the University of Arizona College of Medicine Phoenix. Dr. Behari was recently granted a multi-million dollar initiative award from the Office of Rural Health where she is spearheading the development of a unique multi disciplinary telediabetes program. In her spare time, Dr. Behari enjoys traveling, HIIT classes and spending time with loved ones.
This past week we sat down with Dr. Behari to learn about her experience as a leader in telehealth.
Whitecoatremote.com: Dr. Behari, can you tell us where you currently practice?
Dr. Behari: Phoenix VA Medical Center in Phoenix, Arizona, USA
WCR: How many years have you been in practice?
Dr. Behari: 3 years, 2 of which were during fellowship
WCR: What is your primary area of specialty?
Dr. Behari: Endocrinology
WCR: Approximately how much of your practice is now telemedicine and how long have you been doing telehealth for?
Dr. Behari: Prior to the COVID-19 pandemic, 70% of my practice was seeing patients using telemedicine and 30% of it was face to face visits. During the pandemic, my practice is now 100% virtual.
WCR: In a few words, can you describe your role in Telehealth at your institution?
Dr. Behari: My role is the Medical Telehealth Director at the Phoenix Veteran’s Affairs (VA) Medical Center. I am tasked with using data to determine areas of opportunity to utilize telehealth technology to improve access to specialty care for Veterans. With this information my team and I create virtual clinics where patients can be seen one of two ways: in the comfort of their own home or at a local satellite clinic where a telepresenter facilitates a physical exam for the remote provider. In the 6 months prior to the COVID-19 pandemic, my team and I established TeleRenal, TeleEndocrinology, TeleHIV, and multidisciplinary Telediabetes clinics to bring care to our rural patients.
WCR: What kind of patient population do you serve with Telehealth?
Dr. Behari: The majority of our patients are rural veterans who live more than 50 miles from the Endocrinology clinic located in downtown Phoenix, with as many as 15% living more than 200 miles away.
WCR: In your opinion, what is the major barrier from a patient’s perspective to participate in Telehealth?
Dr. Behari: Although there is some fear of using technology, the main barrier is making sure patients, especially rural patients, are telehealth capable. Being telehealth capable means they have internet (and the bandwidth), the necessary app(s) (which require their App Store or Play Store passwords), and access to microphone/camera if using a non-smartphone/tablet device.
WCR: What kind of feedback have you received from patients while using telehealth?
Dr. Behari: A majority of patients express gratitude that we are able to offer a virtual alternative to driving to their visits. I don’t think I ever realized how much of a burden it is for some of them to arrange transportation and to deal with traffic and parking (especially if they are coming from a rural area and are not used to driving in urban settings). Patients also express waiting for a visit if the provider is running late is not as stressful to them because they are able to wait in the comfort of their homes. In a post-visit 5-question survey during our Telediabetes pilot, 100% of our patients said they would choose to do a telehealth visit over driving to the downtown Phoenix VA campus.
WCR: In your opinion, what is the most beneficial thing that patients get from telehealth?
Dr. Behari: The most beneficial thing is the convenience of the care we are offering to them. Patients don’t have to rush to get to their appointments and they don’t have to be stressed about traffic, parking, or waiting for the provider to come to the room. Working patients take less time off of work and are more likely to make it to their appointments. Family members who are at work or even out of state can join their loved one’s video appointments which helps improve communication and allay anxieties about various health conditions. “Snowbird” patients no longer have to toggle between their summer healthcare providers and their winter healthcare providers—they can see their same providers all year round. Telehealth is essentially the DoorDash of healthcare.
WCR: As a leader in telehealth during the COVID-19 pandemic, describe your strategies that have improved the delivery of healthcare to patients with the use of Telemedicine.
Dr. Behari: During the COVID-19 pandemic, we created a TeleFlu clinic for patients presenting with flu-like symptoms, especially those concerning for COVID-19. When patients call with these symptoms, they are routed to a TeleFlu provider who triages the patient and directs them to e911, the nearest emergency department, or to stay home in self-isolation. As part of this program, we offered options for home monitoring of temperature and pulse oxygenation and options for drive-up testing to keep patients out of the ED. Patients in self-isolation are called daily to ensure symptoms are improving. Within the first four weeks of operation, 300 patients were kept out of the ED with only 18 of them requiring ED visits. In addition to TeleFlu, the use of telehealth across all specialties including primary care, mental health, medical specialties, and surgical specialties have increased significantly. Beyond decreased patient exposure and increased patient satisfaction, this has led to added benefits such as keeping our workforce safe and limiting use of PPE. For the past few years, many of us have heard Telehealth is the future of healthcare and now the pandemic has forced us to bring that future to our present and it seems we are doing so in record time!
The landscape of telemedicine continues to rapidly evolve during the COVID-19 pandemic. Every week, we hope to spotlight physicians from around the country to highlight and discuss their ongoing experiences with telehealth.
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