Azar Rachel, Chan Rachel, Sarkisian Miriam, Burns Robert D, Marcin James P, Gotthardt Christine, De Guzman Keshia R, Rosenthal Jennifer L, Haynes Sarah C
UC Davis School of Medicine, Sacramento, CA, USA.
Department of Pediatrics, UC Davis Health, Sacramento, CA, USA.
J Telemed Telecare. 2024 Mar 22:1357633X241238780. doi: 10.1177/1357633X241238780.
Telehealth has the potential to increase access to care for medically underserved patients. This qualitative study aimed to identify telecare practices used during the COVID-19 pandemic to meet the needs of patients experiencing homelessness, patients with disabilities, and patients with language preference other than English (LOE).
We conducted a secondary qualitative data analysis of 47 clinician interviews at Federally Qualified Health Centers (FQHCs) around the country. Using thematic analysis, transcripts were coded by line-by-line by five qualitative researchers. A multidisciplinary team of telehealth experts, researchers and primary care clinicians reviewed memos and excerpts to generate major themes.
We identified six main areas demonstrating how community providers developed strategies or practices to improve access to care for vulnerable patients: reaching patients experiencing homelessness, serving deaf and hard of hearing patients, improving access for patients with disabilities, serving patients with LOE, improving access for mental and behavioral health services, and educating patients about telehealth. During the pandemic, FQHCs developed innovative solutions to provide access to care for the unhoused, including using telehealth in shelters, vans, and distributing devices like mobile phones and tablets. Telehealth reduced transportation burdens for patients with disabilities and reduced no-show rates for mental health services by adapting group therapy via telehealth features (like break-out rooms) and increasing provider capacity.
Our study identified strategies adopted by FQHCs to serve underserved populations during the COVID-19 pandemic. Our findings highlight the need for enduring strategies to improve health equity through telehealth..
远程医疗有潜力增加医疗服务不足患者获得医疗服务的机会。这项定性研究旨在确定在新冠疫情期间采用的远程护理做法，以满足无家可归患者、残疾患者以及英语以外有语言偏好（LOE）患者的需求。
我们对全国范围内联邦合格健康中心（FQHCs）的47次临床医生访谈进行了二次定性数据分析。采用主题分析法，由五名定性研究人员逐行对访谈记录进行编码。一个由远程医疗专家、研究人员和初级保健临床医生组成的多学科团队审查了备忘录和摘录，以生成主要主题。
我们确定了六个主要领域，展示了社区提供者如何制定策略或做法，以改善弱势患者获得医疗服务的机会：接触无家可归患者、为聋人和听力障碍患者提供服务、改善残疾患者的就医机会、为有语言偏好的患者提供服务、改善精神和行为健康服务的可及性，以及对患者进行远程医疗教育。在疫情期间，FQHCs开发了创新解决方案，为无家可归者提供医疗服务，包括在收容所、货车中使用远程医疗，并分发手机和平板电脑等设备。远程医疗减轻了残疾患者的交通负担，并通过利用远程医疗功能（如分组讨论室）调整团体治疗方式并增加医疗服务提供者的能力，降低了心理健康服务的爽约率。
我们的研究确定了FQHCs在新冠疫情期间为服务不足人群所采取的策略。我们的研究结果强调了需要通过远程医疗制定持久策略以改善健康公平性。
