No abstract

Purpose:Little is known about the attitudes toward and adoption of telehealth services among family physicians (FPs), the largest primary care physician group. We conducted a national survey of FPs, randomly sampled from membership organization files, to investigate use of and barriers to using telehealth services.Methods: Using bivariate analyses, we examined how telehealth usage affected FPs' identified barriers to using telehealth services. Logistic regressions show the factors associated both with using telehealth services and with barriers to using telehealth services.Results: Surveys reached 4980 FPs; 1557 surveys were eligible for analysis (31% response rate). Among FPs, 15% reported using telehealth services during 2014. After controlling for the characteristics of the physicians and their practice, FPs who were based in a rural setting, worked in a practice owned by an integrated health system or other ownership structure, and provided hospital/urgent/emergency care were more likely to use telehealth. Physician and practice characteristics by telehealth use status, sex of the physician, practice location, years in practice, care provided, and practice ownership were associated with the barriers identified. As health care delivery in the United States transitions to a patient-centered, value-based system with improved access to services, physician availability is a challenge. Telehealth could help address this problem. Although the term telehealth has been widely applied and well recognized for more than 4 decades, it lacks a singular definition. Broadly, telehealth is the use of technology to deliver health care services and information from a distance. Telehealth usage has evolved from static "store-and-forward" applications in which information, such as radiologic images, is stored and then forwarded for diagnostic review or a second opinion. Today's clinicians are providing virtual visits in real time through secure, interactive video exchange. These telehealth visits address a wide range of issues, from urgent to chronic, from primary care to subspecialty consultation, and from initial diagnosis to follow-up and management.As the largest health care delivery platform in the United States, the primary care setting 1 offers great potential for expanding telehealth use. TeleThis article was externally peer reviewed.

Direct primary care (DPC) is an emerging practice alternative that (1) eliminates traditional third-party feefor-service billing and (2) charges patients a periodic fee for primary care services. We describe the DPC model by identifying DPC practices across the United States; distinguish it from other practice arrangements, such as the "concierge" practice; and describe the model's pricing using data compiled from existing DPC practices across the United States. Lower price points and a broad distribution of DPC practices were confirmed, but data about quality are lacking. (J Am Board Fam Med 2015;28:793-801.)

There is little relationship between PCGME trainee growth and state need indicators. States should capitalize on opportunities to create explicit linkages between UME, GME, and population need; strategically allocate Medicaid GME funds; and monitor the impact of workforce policies and training institution outputs.