Even before the COVID-19 pandemic, there were barriers for construction workers seeking and receiving medical care and behavioral health services. Lack of access to medical care is an often-cited reason why male-dominated industries like construction have higher rates of chronic physical health conditions, such as obesity, cardiovascular disease, high blood pressure and diabetes.
Likewise, lack of access to behavioral health care services is a risk factor why the construction industry has increasing incidence of alcohol and substance misuse and the second highest rate of suicide. Some of the biggest barriers to medical care and behavioral health services for construction workers include:
1. Construction Culture
- Construction workers are generally paid hourly, and if they’re not at work, they’re not getting paid. During the season, the collective mindset is “gotta make hay while the sun is shining”.
- Construction workers are “tough,” work long hours in hard to harsh conditions, and are used to “playing through the pain.” They believe there is a difference between being hurt and being injured.
2. Job Factors
- The changing schedule and work locations of projects makes it hard for construction workers to schedule regular, recurring medical appointments.
- Construction workers work long schedules with frequent, six-day work weeks and overtime.
3. Individual Reasons
- The social stigma of seeking help for “hidden” behavioral health conditions.
- It is hard to take time off to seek medical care because construction workers don’t want to let their crew down.
4. Health Care System
- Many physical and mental health care providers are not open when construction workers are off work with limited hours of service in the evening or on Saturdays.
- A lack of behavioral health specialists in many areas of the country has increased the waiting time for scheduling initial appointments.
Impact of COVID-19 on Medical Care & Behavioral Health Service
Many non-emergency medical and behavioral health services have been closed during the pandemic for physical distancing to reduce the potential spread of COVID-19. With concerns about the risk of becoming infected with COVID-19, many people are avoiding healthcare services during the outbreak. Many people are afraid to visit their primary care providers or medical clinics and have canceled appointments and ongoing treatments and therapy sessions.
Telehealth and teletherapy services existed before COVID-19, but they were underutilized. With the increasing stress, anxiety and worries of COVID-19, telehealth and teletherapy are expected to remain important after the COVID pandemic. Utilization in remote physician care has risen as the coronavirus pandemic and social distancing continue.
According to CivicScience data, between February and March 2020, the number of adults in the United States who reported intent to use telemedicine rose from 18% to 30%. In February, about 10% said they had tried telemedicine, growing to 17% in March. As stay-at-home orders continue, this number is expected to rise.
Telehealth Vs. Telemedicine Vs. Teletherapy
Many routine, non-emergency medical and behavioral health services can be provided virtually. Services are delivered using computer and telecommunications devices outside of traditional “brick and mortar” health care facilities. In other words, the providers and the patients/clients use audio and video devices to connect virtually to discuss physical or behavioral health concerns. Patients are those who receive medical services, whereas clients are those who receive behavioral health services.
The term telehealth is an all-encompassing one, broadly referring to health information services, health education, and health monitoring delivered remotely. Telehealth technology enables the remote diagnoses and evaluation of patients in addition to the ability to remotely detect fluctuations in the medical condition of the patient or client at home. This allows medications or the specific therapies to be altered accordingly. It also allows for electronically prescribed medications and treatments. It connects individuals to physical health providers, such as doctors, nurses, physical therapists, respiratory therapists and others.
Telemedicine refers to the use of information technologies and electronic communications to provide remote doctor to patient interaction. The digital transmission of medical imaging, remote medical diagnosis and evaluations, and video consultations with specialists are all examples of telemedicine.
Teletherapy specifically describes mental health or talk therapy services provided remotely. Telehealth services can cover a variety of health conditions, whereas teletherapy services only involve treatment for behavioral health or existing mental health conditions. For example, a person may seek teletherapy to cope with anxiety, depression or relationship difficulties. Teletherapy connects people with online counseling services to address their mental health needs, giving access to providers such as psychiatrists, therapists, counselors and other professionals.
Considerations When Selecting Telehealth & Teletherapy
Telemedicine offers important advantages that directly affects quality, continuity of care and speed of delivery. In cases where time is running against a patient, and doctors need to get opinions from other specialists, doctors using telemedicine software can quickly establish a secured video call to get a second opinion saving the patient valuable time and possibly their life.
According to medical news site STAT, UnitedHealthcare estimates that a telemedicine session costs less than $50. That's a much more affordable alternative to a possibly unnecessary visit to the emergency room which could cost more than $2,000. Patient/client co-pays for telehealth and teletherapy sessions are typically lower than standard copays paid by patients before they have met individual deductibles or maximum out-of-pocket family contributions.
One note of caution with accessing telehealth and teletherapy services is that the need for specialized equipment or devices could create a barrier for some workers. Generally, accessing such virtual services requires a computer with an integrated webcam, internal or external microphone, and internet connectivity. Many service providers can accommodate patients and clients using only a tablet or smartphone. Some service providers require patients or clients to download an app to access the caregiver’s service platform.
COVID-19 spurred legislation and administrative rule changes by governmental regulatory agencies that fostered greater flexibility for telehealth and teletherapy services during COVID-19. It is too early to say with certainty that this enabling legislation and regulatory relief will continue in the aftermath of COVID-19. The overall acceptance of telehealth and teletherapy during COVID-19 bodes well for future expansion of this advantageous service delivery platform.
The delivery of medical care and behavioral health services have been disrupted by the pandemic. COVID-19 sparked a need for improved access to care that has been increasingly been met by telehealth and teletherapy. Prior to COVID-19, adoption of telehealth and teletherapy services had lagged the expected level of adoption.
Telehealth has been growing in importance for medical health systems and both private and employee sponsored health plans. There is optimism that telehealth and teletherapy use will continue as a silver lining legacy of the pandemic. This would be game-changing in improving access to health care services and the overall well-being of construction workers.
The Benefits of Telehealth & Teletherapy
- Provides easier access to care
- Offers convenience through flexible schedules
- Ensures continuity of care with providers
- Improves coordination of care
- Decrease social stigma of going to a clinic
- Lowers cost of care
- Achieves high satisfaction ratings from providers and patients/clients
- Reduces downtime for employees and decreases lost earnings