PURPOSE Telehealth is a care delivery model that promises to increase the flexibility and reach of health services. Our objective is to describe patient experiences with video visits performed with their established primary care clinicians. METHODSWe constructed semistructured, in-depth qualitative interviews with adult patients following video visits with their primary care clinicians at a single academic medical center. Data were analyzed with a content analysis approach. RESULTS:Of 32 eligible patients, 19 were successfully interviewed. All patients reported overall satisfaction with video visits, with the majority interested in continuing to use video visits as an alternative to in-person visits. The primary benefits cited were convenience and decreased costs. Some patients felt more comfortable with video visits than office visits and expressed a preference for receiving future serious news via video visit, because they could be in their own supportive environment. Primary concerns with video visits were privacy, including the potential for work colleagues to overhear conversations, and questions about the ability of the clinician to perform an adequate physical examination.CONCLUSIONS Primary care video visits are acceptable in a variety of situations. Patients identified convenience, efficiency, communication, privacy, and comfort as domains that are potentially important to consider when assessing video visits vs in-person encounters. Future studies should explore which patients and conditions are best suited for video visits. INTRODUCTIONT elemedicine, or telehealth, includes telecommunication via a variety of platforms designed to enhance patient-centered health care.1-3 Telehealth in its many forms offers conveniences including increased care accessibility, decreased transportation barriers, and patient empowerment. [4][5][6][7][8] Studies of video visits have demonstrated these benefits in specialty settings including wound care, prenatal genetic screening, family planning, cardiovascular care, and home care. [9][10][11][12][13][14][15] One study of patient experiences with video visits in rural areas found that they were associated with decreased travel costs and lost time/wages, increased access to social support, and better ability to tailor care delivery to patient and family needs. 16Because of these benefits, video visits are being adopted in a variety of settings. Uptake in the United States has occurred most rapidly where reimbursement is favorable. Medicare reimburses for video visits in health professional shortage areas and for specific approved services.17 As a result, much knowledge about patient experiences with video visits is limited to specific disease-related applications and to use in rural settings. [18][19][20] Video visits are increasingly used in other settings, including primary care, but there are limited data on patient experiences with primary care video visits. One study tested video visits with patients communicating via webcam with their primary care physician w...

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Aims To systematically investigate the effect of interventions to overcome therapeutic inertia on glycaemic control in individuals with type 2 diabetes. Materials and Methods We electronically searched for randomized controlled trials or quasi‐experimental studies published between January 1, 2004 and December 31, 2019 evaluating the effect of interventions on glycated haemoglobin (HbA1c) control. Characteristics of included studies and HbA1c difference between intervention and control arms (main outcome) were extracted. Interventions were grouped as: care management and patient education; nurse or certified diabetes educator (CDE); pharmacist; or physician‐based. Results Thirty‐six studies including 22 243 individuals were combined in nonlinear random‐effects meta‐regressions; the median (range) duration of intervention was 1 year (0.9 to 36 months). Compared to the control arm, HbA1c reduction ranged from: −17.7 mmol/mol (−1.62%) to −4.4 mmol/mol (−0.40%) for nurse‐ or CDE‐based interventions; −13.1 mmol/mol (−1.20%) to 3.3 mmol/mol (0.30%) for care management and patient education interventions; −9.8 mmol/mol (−0.90%) to −6.6 mmol/mol (−0.60%) for pharmacist‐based interventions; and −4.4 mmol/mol (−0.40%) to 2.8 mmol/mol (0.26%) for physician‐based interventions. Across the included studies, a reduction in HbA1c was observed only during the first year (6 months: −4.2 mmol/mol, 95% confidence interval [CI] −6.2, −2.2 [−0.38%, 95% CI −0.56, −0.20]; 1 year: −1.6 mmol/mol, 95% CI −3.3, 0.1 [−0.15%, 95% CI −0.30, 0.01]) and in individuals with preintervention HbA1c >75 mmol/mol (9%). Conclusions The most effective approaches to mitigating therapeutic inertia and improving HbA1c were those that empower nonphysician providers such as pharmacists, nurses and diabetes educators to initiate and intensify treatment independently, supported by appropriate guidelines.

BackgroundReal-time video visits are increasingly used to provide care in a number of settings because they increase access and convenience of care, yet there are few reports of health system experiences.ObjectiveThe objective of this study is to report health system and patient experiences with implementation of a telehealth scheduled video visit program across a health system.MethodsThis is a mixed methods study including (1) a retrospective descriptive report of implementation of a telehealth scheduled visit program at one large urban academic-affiliated health system and (2) a survey of patients who participated in scheduled telehealth visits. Health system and patient-reported survey measures were aligned with the National Quality Forum telehealth measure reporting domains of access, experience, and effectiveness of care.ResultsThis study describes implementation of a scheduled synchronous video visit program over an 18-month period. A total of 3018 scheduled video visits were completed across multiple clinical departments. Patient experiences were captured in surveys of 764 patients who participated in telehealth visits. Among survey respondents, 91.6% (728/795) reported satisfaction with the scheduled visits and 82.7% (628/759) reported perceived quality similar to an in-person visit. A total of 86.0% (652/758) responded that use of the scheduled video visit made it easier to get care. Nearly half (46.7%, 346/740) of patients estimated saving 1 to 3 hours and 40.8% (302/740) reported saving more than 3 hours of time. The net promoter score, a measure of patient satisfaction, was very high at 52.ConclusionsA large urban multihospital health system implemented an enterprise-wide scheduled telehealth video visit program across a range of clinical specialties with a positive patient experience. Patients found use of scheduled video visits made it easier to get care and the majority perceived time saved, suggesting that use of telehealth for scheduled visits can improve potential access to care across a range of clinical scenarios with favorable patient experiences.

BackgroundHealthcare systems increasingly engage interprofessional healthcare team members such as case managers, social workers, and community health workers to work directly with patients and improve population health. This study elicited perspectives of interprofessional healthcare team members regarding patient barriers to health and suggestions to address these barriers.MethodsThis is a qualitative study employing focus groups and semi-structured interviews with 39 interprofessional healthcare team members in Philadelphia to elicit perceptions of patients’ needs and experiences with the health system, and suggestions for positioning health care systems to better serve patients. Themes were identified using a content analysis approach.ResultsThree focus groups and 21 interviews were conducted with 26 hospital-based and 13 ambulatory-based participants. Three domains emerged to characterize barriers to care: social determinants, health system factors, and patient trust in the health system. Social determinants included insurance and financial shortcomings, mental health and substance abuse issues, housing and transportation-related limitations, and unpredictability associated with living in poverty. Suggestions for addressing these barriers included increased financial assistance from the health system, and building a workforce to address these determinants directly. Health care system factors included poor care coordination, inadequate communication of hospital discharge instructions, and difficulty navigating complex systems. Suggestions for addressing these barriers included enhanced communication between care sites, patient-centered scheduling, and improved patient education especially in discharge planning. Finally, factors related to patient trust of the health system emerged. Participants reported that patients are often intimidated by the health system, mistrusting of physicians, and fearful of receiving a serious diagnosis or prognosis. A suggestion for mitigating these issues was increased visibility of the health system within communities to foster trust and help providers gain a better understanding of unique community needs.ConclusionThis work explored interprofessional healthcare team members’ perceptions of patient barriers to healthcare engagement. Participants identified barriers related to social determinants of health, complex system organization, and patient mistrust of the health system. Participants offered concrete suggestions to address these barriers, with suggestions supporting current healthcare reform efforts that aim at addressing social determinants and improving health system coordination and adding new insight into how systems might work to improve patient and community trust.Electronic supplementary materialThe online version of this article (doi:10.1186/s12913-016-1751-5) contains supplementary material, which is available to authorized users.