“I was Unsure at First”: A Qualitative Evaluation of Patient Perceptions of VA Clinical Video Telehealth Visits in the V-IMPACT Program
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SUBMITTER: Mog A
PROVIDER: S-EPMC9260561 | biostudies-literature | 2022 Jan
REPOSITORIES: biostudies-literature
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Project description:BACKGROUND:Video-based health care can help address access gaps for patients and is rapidly being offered by health care organizations. However, patients who lack access to technology may be left behind in these initiatives. In 2016, the US Department of Veterans Affairs (VA) began distributing video-enabled tablets to provide video visits to veterans with health care access barriers. OBJECTIVE:This study aimed to evaluate veterans' experiences with VA-issued tablets and identify patient characteristics associated with preferences for video visits vs in-person care. METHODS:A baseline survey was sent to the tablet recipients, and a follow-up survey was sent to the respondents 3 to 6 months later. Multivariate logistic regression was used to identify patient characteristics associated with preferences for care, and we examined qualitative themes around care preferences using standard content analysis methods for coding the data collected in the open-ended questions. RESULTS:Patient-reported access barriers centered around transportation and health-related challenges, outside commitments, and feeling uncomfortable or uneasy at the VA. Satisfaction with the tablet program was high, and in the follow-up survey, approximately two-thirds of tablet recipients preferred care via a tablet (194/604, 32.1%) or expressed that video-based and in-person care were "about the same" (216/604, 35.7%), whereas one-third (192/604, 31.7%) indicated a preference for in-person care. Patients were significantly more likely to report a preference for video visits (vs a preference for in-person visits or rating them "about the same") if they felt uncomfortable in a VA setting, reported a collaborative communication style with their doctor, had a substance use disorder diagnosis, or lived in a place with better broadband coverage. Patients were less likely to report a preference for video visits if they had more chronic conditions. Qualitative analyses identified four themes related to preferences for video-based care: perceived improvements in access to care, perceived differential quality of care, feasibility of obtaining necessary care, and technology-related challenges. CONCLUSIONS:Many recipients of VA-issued tablets report that video care is equivalent to or preferred to in-person care. Results may inform efforts to identify good candidates for virtual care and interventions to support individuals who experience technical challenges.
| S-EPMC7191342 | biostudies-literature
Project description:ImportanceTelehealth has emerged as a means of improving access and reducing cost for medical oncology care; however, use by specialists prior to the coronavirus disease 2019 (COVID-19) pandemic still remained low. Medical oncology professionals' perceptions of telehealth for cancer care are largely unknown, but are critical to telehealth utilization and expansion efforts.ObjectiveTo identify medical oncology health professionals' perceptions of the barriers to and benefits of telehealth video visits.Design, setting, and participantsThis qualitative study used interviews conducted from October 30, 2019, to March 5, 2020, of medical oncology health professionals at the Thomas Jefferson University Hospital, an urban academic health system in the US with a cancer center. All medical oncology physicians, physicians assistants, and nurse practitioners at the hospital were eligible to participate. A combination of volunteer and convenience sampling was used, resulting in the participation of 29 medical oncology health professionals, including 20 physicians and 9 advanced practice professionals, in semistructured interviews.Main outcomes and measuresMedical oncology health professionals' perceptions of barriers to and benefits of telehealth video visits as experienced by patients receiving cancer treatment.ResultsOf the 29 participants, 15 (52%) were women and 22 (76%) were White, with a mean (SD) age of 48.5 (12.0) years. Respondents' perceptions were organized using the 4 domains of the National Quality Forum framework: clinical effectiveness, patient experience, access to care, and financial impact. Respondents disagreed on the clinical effectiveness and potential limitations of the virtual physical examination, as well as on the financial impact on patients. Respondents also largely recognized the convenience and improved access to care enabled by telehealth for patients. However, many reported concern regarding the health professional-patient relationship and their limited ability to comfort patients in a virtual setting.Conclusions and relevanceMedical oncology health professionals shared conflicting opinions regarding the barriers to and benefits of telehealth in regard to clinical effectiveness, patient experience, access to care, and financial impact. Understanding oncologists' perceptions of telehealth elucidates potential barriers that need to be further investigated or improved for telehealth expansion and continued utilization; further research is ongoing to assess current perceptions of health professionals and patients given the rapid expansion of telehealth during the COVID-19 pandemic.
| S-EPMC7809588 | biostudies-literature
Project description:IntroductionTelehealth utilization surged during the COVID-19 pandemic, offering expanded health care access. Audio-only visits emerged as a crucial tool for patients facing technology or connectivity barriers to still use telehealth. This qualitative study aims to better understand patient perceptions of audio-only versus video telehealth visits during the COVID-19 pandemic, and how patients perceive the role of each in their overall health care.MethodsSemi-structured interviews were conducted with 14 adult patients seeking care at an academic medical center located in the Southeast region of the United States. Patients had experienced both an audio-only and video telehealth visit within the past 6 months. Topics covered in the interview included comfort, preference, quality, and communication during each type of visit. Interviews were transcribed verbatim, coded, and analyzed using a general inductive approach.ResultsParticipants valued having both modalities available largely due to convenience and saw these visits as supplemental or supporting their in-person care. Preferences for visit types were varied among participants and were context-specific, influenced by visit purpose and provider rapport. Patients viewed audio-only visits favorably for informational follow-ups and highlighted their convenience, particularly for multitasking and caregiving duties. In contrast, video visits were seen as more effective for communication due to visual cues and better suited for demonstrating health conditions. Audio-only visits were also seen as less technology-dependent and served as a vital back-up to failed video encounters.DiscussionDespite varied preferences, patients perceived both modalities as complementary to in-person care. Concerns around the quality of care were mitigated by patients' and providers' judicious use of visit types based on clinical appropriateness and existing rapport. The results emphasize the necessity and flexibility of audio-only visits in ensuring equitable access to telehealth, especially for those with technology limitations or demanding responsibilities. To maintain the access and convenience afforded by telehealth and ensure these benefits are offered equitably, policy makers and health care organizations must continue to provide flexible telehealth options, including audio-only visits.
| S-EPMC11002560 | biostudies-literature
Project description:Telephone consultation and triage services are increasingly being used to deliver health advice. Availability of high speed internet services in remote areas allows healthcare providers to move from telephone to video telehealth services. Current approaches for assessing video services have limitations. This study aimed to identify the challenges for service providers associated with transitioning from audio to video technology.Using a mixed-method, qualitative approach, we observed training of service providers who were required to switch from telephone to video, and conducted pre- and post-training interviews with 15 service providers and their trainers on the challenges associated with transitioning to video. Two full days of simulation training were observed. Data were transcribed and analysed using an inductive approach; a modified constant comparative method was employed to identify common themes.We found three broad categories of issues likely to affect implementation of the video service: social, professional, and technical. Within these categories, eight sub-themes were identified; they were: enhanced delivery of the health service, improved health advice for people living in remote areas, safety concerns, professional risks, poor uptake of video service, system design issues, use of simulation for system testing, and use of simulation for system training.This study identified a number of unexpected potential barriers to successful transition from telephone to the video system. Most prominent were technical and training issues, and personal safety concerns about transitioning from telephone to video media. Addressing identified issues prior to implementation of a new video telehealth system is likely to improve effectiveness and uptake.
| S-EPMC5557607 | biostudies-other
Project description:The Affordable Connectivity Program (ACP) aimed to narrow the digital divide by providing discounted internet services for millions of low-income households during the COVID-19 pandemic. This study examined associations between enrollment in the ACP and Telehealth visits in a racially diverse low-income population. Data were obtained via a cross-sectional survey of 213 respondents. Three multivariable regression models examined associations between ACP and three dependent variables, separately: (i) Used telehealth in the past 12 months, (ii) Had 1 or more video visits/consults in the past 12 months, and (iii) Had 1 or more telephone visits/consults in the past 12 months. 41% of survey respondents identified as non-Hispanic Black individuals, 33% as non-Hispanic White individuals, and 22% as Hispanic individuals. 69% reported a pre-tax annual household income of less than $35,000. Only 2 of 10 respondents had heard of ACP and were enrolled, while approximately 4 in 10 had never heard of it. Respondent knowledge/enrollment in the ACP was not significantly associated with telehealth, video consult, or telephone usage. Other demographic characteristics including race, income, educational attainment, and biological sex were significantly associated with telehealth, video, and telephone consults. We observed no association between ACP and telehealth use. While this finding is concerning, it offers an opportunity to reflect on potential reasons for ACP adoption gaps, such as digital literacy, device availability, and potential misconceptions about telehealth services.
| S-EPMC11747251 | biostudies-literature
Project description:Clinical Video Telehealth (CVT) use is increasing and allows geographically separated care; however, this separation may affect participants behaviors. Using semi-structured in-depth interviews, we asked CVT nurse practitioners (NP), staff and patients at a VA Medical Center about perspectives on how CVT effects communication and identified three themes. They remarked on the complexity of scheduling appointments, local barriers to care, and acutely ill patients. NPs discussed how CVT altered sensory collection during the physical exam and differences in building provider-patient relationships. Patients perceptions mirrored these themes. NPs identified how CVT requires different workflow, behaviors, and use of their senses. Patients expressed similar concerns with CVT.
| S-EPMC8404211 | biostudies-literature
Project description:ObjectiveTo test an intervention designed to improve patient engagement in telehealth visits by encouraging patients to use active communication behaviors.MethodsUS Veterans with type 2 diabetes mellitus receiving primary care using telehealth were randomized 1:1 to receive both a pre-visit educational video and pamphlet (intervention) or pamphlet alone (control) prior to their scheduled telehealth visit. Data were collected before and after the intervention from the medical record and at telephone interviews (questionnaires). Analyses compared the intervention and control groups using bivariate statistics and multiple regression.ResultsThere were no statistically significant differences in baseline Hemoglobin A1c (HbA1c) between intervention and control groups (P > 0.05). Patient's ratings of physicians' communication and post-visit empathy were higher (P ≤ 0.05) in the intervention group than control group and after adjusting for baseline values the intervention group reported higher scores on post-visit therapeutic alliance with the provider and higher patient engagement, compared with the control group, P = 0.01 and P = 0.04, respectively, but post-visit HbA1c was not statistically different.ConclusionsThe educational video was useful as pre-visit preparation for patients prior to a primary care telehealth visit.InnovationThis study showed the efficacy of a pre-visit video to improve patient engagement and therapeutic alliance after telehealth visits.ClinicalTrials.govIdentifier: NCT02522494.
| S-EPMC10194152 | biostudies-literature
Project description:BackgroundThe use of telehealth to deliver healthcare remotely has increased significantly over the past two decades. Despite increased use among certain demographic groups, uptake among rural populations continues to lag when compared to urban populations. Barriers such as limited access to the internet and patient perceptions regarding the lower quality of remote visits on patient-provider relationships may contribute to lower use among rural populations. Telehealth delivered in community settings like County Extension offers an innovative opportunity to reduce these barriers and associated disparities among rural communities. The aim of the current pilot study was to assess the implementation of telehealth kiosks in a rural community setting.MethodsIn this cross-sectional, implementation pilot study, we utilize a mixed methods approach to assess patient centered care (PCC) among adults dwelling in rural areas and using telehealth services at their local County Extension offices. Twenty-one participants across four counties enrolled and completed telehealth visits with a nurse practitioner working in a well-known academic medical center's endocrinology clinic. Telehealth visits were audio recorded, transcribed professionally, and members of the research team analyzed the transcripts. Patients completed paper and pencil questionnaires at the end of their visit and data were entered into RedCap. Questionnaire data was analyzed for descriptive statistics.ResultsThis article describes aspects of patient centered communication through analysis of patient-clinician conversations during recorded telehealth visits and patients' responses on a paper questionnaire assessing self-reported scores on the revised Patient Perceptions of Patient-Centeredness (PPPC-R) questionnaire. Patients reported scores indicative of positive perceptions of PCC during their visits. The self-reported data from questionnaires and the transcripts from the audio recording supported this finding. We also provide an overview of lessons learned from testing the implementation of a novel health information technology in a non-traditional setting.ConclusionsOverall, telehealth is a feasible option for helping to reduce transportation and internet barriers while increasing access to specialty care in rural communities. Using a unique combination of implementation and communication science frameworks will help us to understand and define best-practices, collaboration networks and strategies for the effective use of telehealth in rural settings.
| S-EPMC11811651 | biostudies-literature
Project description:BackgroundMost health insurance organizations reimbursed both video and audio-only (i.e., phone) visits during the COVID-19 pandemic, but may discontinue phone visit coverage after the pandemic. The impact of discontinuing phone visit coverage on various patient subgroups is uncertain.ObjectiveIdentify patient subgroups that are more probable to access telehealth through phone versus video.DesignRetrospective cohort.PatientsAll patients at a U.S. academic medical center who had an outpatient visit that was eligible for telehealth from April through June 2020.Main measuresThe marginal and cumulative effect of patient demographic, socioeconomic, and geographic characteristics on the probability of using video versus phone visits.Key resultsA total of 104,204 patients had at least one telehealth visit and 45.4% received care through phone visits only. Patient characteristics associated with lower probability of using video visits included age (average marginal effect [AME] -6.9% for every 10 years of age increase, 95%CI -7.8, -4.5), African-American (AME -10.2%, 95%CI -11.4, -7.6), need an interpreter (AME -19.3%, 95%CI -21.8, -14.4), Medicaid as primary insurance (AME -12.1%, 95%CI -13.7, -9.0), and live in a zip code with low broadband access (AME -7.2%, 95%CI -8.1, -4.8). Most patients had more than one factor which further reduced their probability of using video visits.ConclusionsPatients who are older, are African-American, require an interpreter, use Medicaid, and live in areas with low broadband access are less likely to use video visits as compared to phone. Post-pandemic policies that eliminate insurance coverage for phone visits may decrease telehealth access for patients who have one or more of these characteristics.
| S-EPMC8597874 | biostudies-literature
Project description:BackgroundElectronic visits (e-visits) are billable, asynchronous patient-initiated messages that require at least five minutes of medical decision-making by a provider. Unequal use of patient portal tools like e-visits by certain patient populations may worsen health disparities. To date, no study has attempted to qualitatively assess perceptions of e-visits in older adults.ObjectiveIn this qualitative study, we aimed to understand patient perceptions of e-visits, including their perceived utility, barriers to use, and care implications, with a focus on vulnerable patient groups.MethodsWe conducted a qualitative study using in-depth structured individual interviews with patients from diverse backgrounds to assess their knowledge and perceptions surrounding e-visits as compared with unbilled portal messages and other visit types. We used content analysis to analyze interview data.ResultsWe conducted 20 interviews, all in adults older than 65 years. We identified 4 overarching coding categories or themes. First, participants were generally accepting of the concept of e-visits and willing to try them. Second, nearly two-thirds of the participants voiced a preference for synchronous communication. Third, participants had specific concerns about the name "e-visit" and when to choose this type of visit in the patient portal. Fourth, some participants indicated discomfort using or accessing technology for e-visits. Financial barriers to the use of e-visits was not a common theme.ConclusionsOur findings suggest that older adults are generally accepting of the concept of e-visits, but uptake may be limited due to their preference for synchronous communication. We identified several opportunities to improve e-visit implementation.
| S-EPMC10257108 | biostudies-literature