Bridging the Gaps: Strengthening Patient Engagement and Interprofessional Telehealth in Primary Care

Dear Editor,

McGraw et al.’s ¹ scoping review on chronic disease patients’ involvement with interprofessional telehealth in primary care delivers important evidence about the role of telehealth in enabling continuity of care, satisfaction, and patient-centered care to evolve. Their combined emphasis on facilitators and barriers provides a solid base for potential health policy and implementation. While I applaud the authors’ attention to collaboration dynamics and suggest 3 additional considerations: an equity-informed telehealth strategy, embedding digital health literacy in interprofessional workflows, and the role of culturally responsive engagement models for future practice.

First, although the review points to technical and relational barriers to telehealth uptake, the question of digital exclusion should be emphasized more. Internet access is not universally available, especially among older adults, members of racial and ethnic minority groups, and people in rural areas.^2,3 Societal factors, including distance, cost, and language barriers, intersect with the burden of chronic disease to create a paradox: the most in need have the least access to care it is generally thought that remote access to care will help to alleviate low access to care for chronic diseases, but on one hand remote access to care remains low in many settings, and on the other hand the impact of the digital transformation remains suboptimal. Future research and policies must have a digital equity lens, developed such as the provision of subsidized technology, platform with interpreter integrated, and collaboration with community-based digital inclusion initiatives.

Second, the review focuses on the lack of provider training, but might have also included team-based digital health literacy interventions. Although individual clinician proficiency is a prerequisite, concertive competence within Telehealth requires shared knowledge for use of digital platforms, protocols, and patient-centered communication in a virtual world. ⁴ Data from interprofessional education suggests that combined digital simulation training and telepractice rounds have a positive impact on provider confidence as well as patient outcomes. ⁵ Incorporation of digital skills into team-based continuing education may be one way to counter siloed practice that McGraw et al.¹ identified.

Third, albeit the inclusion of patients in telehealth is essential, this should make sense when seen from a cultural and contextual perspective. Cultural, language, and past healthcare experiences inform patients’ lived experiences with chronic illness and their comfort and engagement in virtual care.^6,7 The review’s plea for patient-centered models could be realized through participative design approaches, where diverse patients are engaged in the co-design of (new) telehealth tools, decisional aids, and care routing. ⁸ Furthermore, telehealth guidance should advise on culturally safe interaction, particularly for indigenous, immigrant, and low-literacy communities often excluded from digital health research.

McGraw et al. ¹ rightly contend that telehealth is here to stay and must be adapted for the benefit of patients and providers. I add my voice to theirs in calling for structured implementation models and propose that national and provincial health authorities consider incorporating an audit of digital equity, interprofessional telehealth training programs, and culturally responsive care frameworks in telehealth rollouts. Without these deliberate tactics, I worry that the potential of interprofessional telehealth to deliver genuinely equitable, patient-centered primary care will not be fulfilled.

Assist. Prof. Dominikus David Biondi Situmorang, S.Pd., M.Pd., M.Si., C.T., C.PS., C.BNLP.
Department of Guidance and Counseling, Atma Jaya Catholic University of Indonesia, DKI Jakarta, Indonesia