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Barriers to Telemedicine Use: Qualitative Analysis of Provider Perspectives During the COVID-19 Pandemic.

作者信息

Patel Milan, Berlin Hanna, Rajkumar Abishek, Krein Sarah L, Miller Rebecca, DeVito Jessie, Roy Jake, Punch Margaret, Ellimootti Chad, Peahl Alex F

机构信息

Department of Urology, Loyola University Medical Center, Maywood, IL, United States.

University of Michigan Medical School, Ann Arbor, MI, United States.

出版信息

JMIR Hum Factors. 2023 Jun 26;10:e39249. doi: 10.2196/39249.


DOI:10.2196/39249
PMID:37358887
原文链接:https://pmc.ncbi.nlm.nih.gov/articles/PMC10337245/
Abstract

BACKGROUND: Though telemedicine is a promising approach for removing barriers to care and improving access for patients, telemedicine use for many medical specialties has decreased from its peak during the acute COVID-19 public health crisis. Understanding the barriers and facilitators to the maintenance of web-based visits-one key component of telemedicine-is critical for ensuring the continuous availability of this service for patients. OBJECTIVE: The purpose of this study is to describe medical providers' perceived barriers and facilitators to the continued use of web-based visits to inform quality improvement efforts and promote sustainability. METHODS: We performed a qualitative content analysis of free-text responses from a survey of medical providers administered from February 5-14, 2021, at a large, midwestern academic institution, including all providers from medical professions that offered telemedicine (eg, physicians, residents or fellows, nurse practitioners, physicians assistants, or nurses) who completed at least 1 web-based visit from March 20, 2020, to February 14, 2021. The primary outcome was the experience of providing web-based visits, including barriers and facilitators to continued usage of web-based visits. Survey questions included 3 major domains: quality of care, technology, and satisfaction. Responses were coded using qualitative content analysis and further analyzed through a matrix analysis to understand the providers' perspectives and elucidate key barriers and facilitators of web-based visit usage. RESULTS: Of 2692 eligible providers, 1040 (38.6%) completed the survey, of whom 702 were providers from medical professions that offered telemedicine. These providers spanned 7 health care professions and 47 clinical departments. The most common professions represented were physicians (486/702, 46.7%), residents or fellows (85/702, 8.2%), and nurse practitioners (81/702, 7.8%), while the most common clinical departments were internal medicine (69/702, 6.6%), psychiatry (69/702, 6.6%), and physical medicine and rehabilitation (67/702, 6.4%). The following 4 overarching categories of provider experience with web-based visits emerged: quality of care, patient rapport, visit flow, and equity. Though many providers saw web-based visits as a tool for improving care access, quality, and equity, others shared how appropriate selection of web-based visits, support (eg, patient training, home devices, and broadband access), and institutional and nationwide optimization (eg, relaxation of licensing requirements across state borders and reimbursement for phone-only modalities) were needed to sustain web-based visits. CONCLUSIONS: Our findings demonstrate key barriers to the maintenance of telemedicine services following the acute public health crisis. These findings can help prioritize the most impactful methods of sustaining and expanding telemedicine availability for patients who prefer this method of care delivery.

摘要
https://cdn.ncbi.nlm.nih.gov/pmc/blobs/fb1f/10337245/60a40de06c06/humanfactors_v10i1e39249_fig1.jpg
https://cdn.ncbi.nlm.nih.gov/pmc/blobs/fb1f/10337245/60a40de06c06/humanfactors_v10i1e39249_fig1.jpg
https://cdn.ncbi.nlm.nih.gov/pmc/blobs/fb1f/10337245/60a40de06c06/humanfactors_v10i1e39249_fig1.jpg

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本文引用的文献

[1]
Comparison of care accessibility, costs, and quality with face-to-face and telehealth epilepsy clinic visits.

Epilepsy Behav. 2022-2

[2]
Video Visits are Practical for the Follow-up and Management of Established Male Infertility Patients.

Urology. 2021-8

[3]
Remote Home Monitoring of Patients With Cancer During the COVID Pandemic: A Pilot Study.

JCO Oncol Pract. 2021-9

[4]
Use of Telehealth by Surgical Specialties During the COVID-19 Pandemic.

JAMA Surg. 2021-7-1

[5]
Paying for Telemedicine After the Pandemic.

JAMA. 2021-2-2

[6]
Virtual Care, Telemedicine Visits, and Real Connection in the Era of COVID-19: Unforeseen Opportunity in the Face of Adversity.

JAMA. 2021-2-2

[7]
Variation In Telemedicine Use And Outpatient Care During The COVID-19 Pandemic In The United States.

Health Aff (Millwood). 2021-2

[8]
Medical Oncology Professionals' Perceptions of Telehealth Video Visits.

JAMA Netw Open. 2021-1-4

[9]
Trends in Outpatient Care Delivery and Telemedicine During the COVID-19 Pandemic in the US.

JAMA Intern Med. 2021-3-1

[10]
Virtual mental health care in the Veterans Health Administration's immediate response to coronavirus disease-19.

Am Psychol. 2021-1

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