Ivanova Julia, Cummins Mollie R, Soni Hiral, Ong Triton, Bunnell Brian E, López Esteban, Welch Brandon M
Doxy.me Research, Doxy.me Inc, Charleston, SC, United States.
Department of Biomedical Informatics, College of Nursing and Spencer Fox Eccles School of Medicine, University of Utah, Salt Lake City, UT, United States.
JMIR Hum Factors. 2025 Mar 20;12:e65419. doi: 10.2196/65419.
In response to the COVID-19 pandemic, the United States extended regulatory flexibilities to make telemedicine more accessible to providers and patients. Some of these flexibilities allowed providers to intake patients over telemedicine and prescribe certain scheduled medications without an in-person visit.
We aim to understand providers' parameters for their comfort in prescribing over telemedicine and report on solutions providers have adopted in response to potential barriers and challenges in prescribing via telemedicine.
As part of a larger mixed methods study between February and April 2024, we conducted 16 semistructured interviews with mental health providers who prescribe via telemedicine within the United States. We used the results of a web-based, cross-sectional survey to develop a codebook and support recruitment. We analyzed a subsection of the 16 interviews using content analysis to capture comfort, barriers, and workarounds in telemedicine prescribing. We reported codes by frequency and by provider.
Participants were typically male (11/16, 69%), provided care mostly or completely over telemedicine (11/16, 69%), and were psychiatrists (8/16, 50%) or other physician (3/16, 19%). Providers' primary states (10/16, 62%) of practice included Oregon, Texas, New York, and California. The content analysis yielded a total of 234 codes, with three main codes-comfort (98/234, 41.9%), barriers or challenges (85/234, 36.3%), and workarounds or solutions (27/234, 11.5%)-and two subcodes-uncomfortable prescribing (30/98, 31%) and comfortable prescribing (68/98, 69%) over telemedicine. Participants reported being comfortable prescribing over telemedicine as long as they could meet their main parameters of working within their expertise, having access to needed patient health information, and being compliant with rules and regulations. Participants reported frustrations with e-prescription workflows and miscommunications with pharmacies. Solutions to ease frustrations and alleviate discomforts in prescribing over telemedicine included developing workflows to help patients complete laboratory tests and physical examinations and directly communicating with pharmacies.
By applying content analysis to the semistructured provider interviews, we found that physicians are comfortable prescribing via telemedicine when they feel they are practicing within their personal parameters for safety. While many providers experience frustrations such as miscommunication with pharmacies, these barriers appear to not prevent them from telemedicine prescribing. With expected changes in 2024 and 2025 to the US laws and regulations for telemedicine prescribing, we may see changes in provider comfort in prescribing.
为应对新冠疫情，美国放宽了监管灵活性，以使远程医疗对医疗服务提供者和患者而言更易获得。其中一些灵活性措施允许医疗服务提供者通过远程医疗接诊患者并开具某些处方药，而无需进行面对面就诊。
我们旨在了解医疗服务提供者对通过远程医疗开处方感到安心的参数，并报告医疗服务提供者针对远程医疗开处方中潜在障碍和挑战所采取的解决方案。
作为2024年2月至4月一项规模更大的混合方法研究的一部分，我们对美国境内通过远程医疗开处方的心理健康服务提供者进行了16次半结构化访谈。我们利用一项基于网络的横断面调查结果来制定编码手册并支持招募工作。我们运用内容分析法对16次访谈中的一个子部分进行分析，以获取远程医疗开处方中的安心因素、障碍和应对方法。我们按出现频率和提供者报告编码情况。
参与者大多为男性（11/16，69%），主要或完全通过远程医疗提供护理（11/16，69%），并且是精神科医生（8/16，50%）或其他医生（3/16，19%）。医疗服务提供者执业的主要州（10/16，62%）包括俄勒冈州、得克萨斯州、纽约州和加利福尼亚州。内容分析共产生了234个编码，有三个主要编码——安心因素（98/234，41.9%）、障碍或挑战（85/234，36.3%）以及应对方法或解决方案（27/234，11.5%）——还有两个子编码——远程医疗开处方时不安心（30/98，31%）和安心（68/98，69%）。参与者报告称，只要能满足其在专业范围内工作、获取所需患者健康信息以及遵守规章制度等主要参数，他们就对通过远程医疗开处方感到安心。参与者报告了对电子处方工作流程的不满以及与药房的沟通不畅。缓解远程医疗开处方中的不满和不适的解决方案包括制定工作流程以帮助患者完成实验室检查和体格检查，以及与药房直接沟通。
通过对医疗服务提供者的半结构化访谈应用内容分析法，我们发现医生在觉得自己是在个人安全参数范围内执业时，对通过远程医疗开处方感到安心。虽然许多医疗服务提供者会遇到如与药房沟通不畅等挫折，但这些障碍似乎并未阻止他们进行远程医疗开处方。随着2024年和2025年美国远程医疗开处方法律法规的预期变化，我们可能会看到医疗服务提供者开处方时的安心程度发生变化。
