A Qualitative Study of Primary Care Physicians’ Experiences With Telemedicine During COVID-19

Gómez, Teresita; Anaya, Yohualli Balderas-Medina; Shih, Kevin J.; Tarn, Derjung M.

doi:10.3122/jabfm.2021.s1.200517

Cited by 211 publications

(289 citation statements)

References 30 publications

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“…Clinicians had to quickly pivot to provide substantial amounts of virtual care, resulting in the need to learn new workflows. In qualitative studies examining clinician telemedicine perspectives in the pandemic’s wake, clinicians reported challenges with physical examination, workflow concerns, burnout, and reduced personal connection with patients [ 8 , 9 ]. Although these studies set a baseline for understanding clinician barriers to telemedicine, they only explored perceptions of a relatively small number of physicians [ 8 , 10 ] or were limited to physicians from one specialty [ 9 , 11 - 13 ].…”

Section: Introductionmentioning

confidence: 99%

Clinician Perspectives on Telemedicine: Observational Cross-sectional Study

Alkureishi¹,

Choo²,

Lenti³

et al. 2021

JMIR Hum Factors

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Background Since the COVID-19 pandemic onset, telemedicine has increased exponentially across numerous outpatient departments and specialties. Qualitative studies examining clinician telemedicine perspectives during the pandemic identified challenges with physical examination, workflow concerns, burnout, and reduced personal connection with patients. However, these studies only included a relatively small number of physicians or were limited to a single specialty, and few assessed perspectives on integrating trainees into workflows, an important area to address to support the clinical learning environment. As telemedicine use continues, it is necessary to understand a range of clinician perspectives. Objective This study aims to survey pediatric and adult medicine clinicians at the University of Chicago Medical Center to understand their telemedicine benefits and barriers, workflow impacts, and training and support needs. Methods In July 2020, we conducted an observational cross-sectional study of University of Chicago Medical Center faculty and advanced practice providers in the Department of Medicine (DOM) and Department of Pediatrics (DOP). Results The overall response rate was 39% (200/517; DOM: 135/325, 42%; DOP: 65/192, 34%); most respondents were physicians (DOM: 100/135, 74%; DOP: 51/65, 79%). One-third took longer to prepare for (65/200, 33%) and conduct (62/200, 32%) video visits compared to in-person visits. Male clinicians reported conducting a higher percentage of telemedicine visits by video than their female counterparts (P=.02), with no differences in the number of half-days per week providing direct outpatient care or supervising trainees. Further, clinicians who conducted a higher percentage of their telemedicine by video were less likely to feel overwhelmed (P=.02), with no difference in reported burnout. Female clinicians were “more overwhelmed” with video visits compared to males (41/130, 32% vs 12/64, 19%; P=.05). Clinicians 50 years or older were “less overwhelmed” than those younger than 50 years (30/85, 35% vs 23/113, 20%; P=.02). Those who received more video visit training modalities (eg, a document and webinar on technical issues) were less likely to feel overwhelmed by the conversion to video visits (P=.007) or burnt out (P=.009). In addition, those reporting a higher ability to technically navigate a video visit were also less likely to feel overwhelmed by video visits (P=.02) or burnt out (P=.001). The top telemedicine barriers were patient-related: lack of technology access, lack of skill, and reluctance. Training needs to be focused on integrating learners into workflows. Open-ended responses highlighted a need for increased support staff. Overall, more than half “enjoyed conducting video visits” (119/200, 60%) and wanted to continue using video visits in the future (150/200, 75%). Conclusions Despite positive telemedicine experiences, more support to facilitate video visits for patients and clinicians is needed. Further, clinicians need additional training on trainee education and integration into workflows. Further work is needed to better understand why gender and age differences exist. In conclusion, interventions to address clinician and patient barriers, and enhance clinician training are needed to support telemedicine’s durability.

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Section: Introductionmentioning

confidence: 99%

Clinician Perspectives on Telemedicine: Observational Cross-sectional Study

Alkureishi¹,

Choo²,

Lenti³

et al. 2021

JMIR Hum Factors

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“…These findings also emphasize the critical importance of placing equitable access at the forefront of the telemedicine expansion and are consistent with concerns noted in recent literature in this area. 24 Our descriptive study is not without limitations. This survey was administered to a group of physicians affiliated with a large, urban academic hospital system.…”

Section: Discussionmentioning

confidence: 92%

The Telemedicine Takeover: Lessons Learned During an Emerging Pandemic

Wilhite

Altshuler

Fisher

et al. 2022

Telemedicine and e-Health

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Introduction: Health care systems rose to the challenges of COVID-19 by creating or expanding telehealth programs to ensure that patients could access care without an in-person appointment. Traditionally, physicians receive limited formal telemedicine training, making preparedness for this transition uneven. To describe challenges to and attitudes toward providing virtual patient care, we distributed a survey to physicians within our system who largely had no formal prior training/experience with telemedicine, but transitioned to routine telemedicine use. Data collected are then used to offer actionable recommendations for health system leaders and medical educators. Materials and Methods: Surveys were distributed to all faculty outpatient general internal medicine physicians working at any New York University Langone Health, New York City Health + Hospitals/Bellevue and Gouverneur, and the VA NY Harbor Health System (n = 378) in mid-2020. Survey items consisted of Likert and open-ended questions related to experience with televisits (13 items) and attitudes toward care (24 items). Results: Telehealth-related challenges varied by site and modality. Primary challenges included establishing a connection from the patient's (98%) or physician's end (84%) and difficulty in the following domains: working with team members (39%), physical examinations (95%), establishing new patient relationships (70%), and taking history (40%), among others. In thematic analysis, significant themes with illustrative qualitative commentary emerged related to technological challenges, new systems issues, and new patient/ physician communication experiences.Discussion: Experience differences were rooted in the type of technology employed. Safety-net practices conducted mostly telephonic visits, whereas private outpatient sites utilized video, despite both using identical electronic medical records. As we consider a ''new normal'' and prolonged community transmission of COVID-19 infection, it is essential to establish telemedicine training, tools, and protocols that meet the needs of both patients and physicians.

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“…It is also critical to train learners on how to leverage telemedicine to do things we cannot do in the in-person clinic setting. For example, the ability to have a family member join in from a separate location for a virtual visit with their elderly parent may add critical information that would not have been obtainable otherwise [29]. Similarly, information can be gleaned by using video as an opportunity to assess relevant parts of a patient's home environment in a way that is akin to the traditional and time-honored home-visit.…”

Section: Teaching Patient-centered Telemedicinementioning

confidence: 99%

“…Similarly, information can be gleaned by using video as an opportunity to assess relevant parts of a patient's home environment in a way that is akin to the traditional and time-honored home-visit. In this way, video visits can be used to identify potential fall risks in a patient's home, accurately review how patients organize and take their medications [29], or to identify safety hazards present in the homes of pediatric patients. Virtual visits can also be used to augment in-person care to allow for touchpoints between clinic visits; for example, to assess medication tolerance or symptom relief or for follow-up educational sessions that may not require a full physical exam or assessment.…”

Section: Teaching Patient-centered Telemedicinementioning

confidence: 99%

Teaching Telemedicine: The Next Frontier for Medical Educators

Alkureishi¹,

Lenti²,

Choo³

et al. 2021

JMIR Med Educ

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The COVID-19 pandemic has pushed telemedicine to the forefront of health care delivery, and for many clinicians, virtual visits are the new normal. Although telemedicine has allowed clinicians to safely care for patients from a distance during the current pandemic, its rapid adoption has outpaced clinician training and development of best practices. Additionally, telemedicine has pulled trainees into a new virtual education environment that finds them oftentimes physically separated from their preceptors. Medical educators are challenged with figuring out how to integrate learners into virtual workflows while teaching and providing patient-centered virtual care. In this viewpoint, we review principles of patient-centered care in the in-person setting, explore the concept of patient-centered virtual care, and advocate for the development and implementation of patient-centered telemedicine competencies. We also recommend strategies for teaching patient-centered virtual care, integrating trainees into virtual workflows, and developing telemedicine curricula for graduate medical education trainees by using our TELEMEDS framework as a model.

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A Qualitative Study of Primary Care Physicians’ Experiences With Telemedicine During COVID-19

Cited by 211 publications

References 30 publications

Clinician Perspectives on Telemedicine: Observational Cross-sectional Study

Clinician Perspectives on Telemedicine: Observational Cross-sectional Study

The Telemedicine Takeover: Lessons Learned During an Emerging Pandemic

Teaching Telemedicine: The Next Frontier for Medical Educators

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