Barriers and facilitators to implementing telehealth services during the COVID-19 pandemic: A qualitative analysis of interviews with cystic fibrosis care team members

Abstract

Background The COVID-19 pandemic forced cystic fibrosis (CF) care programs to rapidly shift from in-person care delivery to telehealth. Our objective was to provide a qualitative exploration of facilitators and barriers to: 1) implementing high-quality telehealth and 2) navigating reimbursement for telehealth services. Methods We used data from the 2020 State of Care CF Program Survey (n=286 U.S. care programs) administered in August-September to identify two cohorts of programs, with variation in telehealth quality (n=12 programs) and reimbursement (n=8 programs). We conducted focus groups and semi-structured interviews with CF program directors and coordinators in December 2020, approximately 9 months from onset of the pandemic. We used the Consolidated Framework for Implementation Research to identify facilitators and barriers of implementation, and inductive thematic analysis to identify facilitators and barriers of reimbursement. Results Factors differentiating programs with greater and lower perceived telehealth quality included telehealth characteristics (perceived advantage over in-person care, cost, platform quality); external influences (needs and resources of those served by the CF program), characteristics of the CF program (compatibility with workflows, relative priority, available resources); characteristics of team members (individual stage of change), and processes for implementation (engaging patients and teams). Reimbursement barriers included documentation to optimize billing; reimbursement of multi-disciplinary team members, remote monitoring, and telephone-only telehealth; and lower volume of patients. Conclusions A number of factors are associated with successful implementation and reimbursement of telehealth. Future efforts should provide guidance and incentives that support telehealth delivery and infrastructure, share best practices across CF programs, and remove barriers.

Telehealth and CFTR modulators: Accelerating innovative models of cystic fibrosis care

“…Despite these challenges, many CF care teams successfully delivered interdisciplinary care through telehealth. Notably, the quality of telehealth care was reported to be equal or better to in-person care by over half of both care team members and patients/families [20][21][22] .…”

“…While PwCF and families acknowledge the benefit of reduced travel and time burden associated with telehealth visits, limitations and barriers to its use were identified [22] . For example, telehealth was less appropriate for sensitive conversations, assessing family dynamics, and for younger children who may not engage as readily via a computer screen [20][21][22] . The use of telehealth was preferred to a greater extent by adult teams as compared to pediatric teams [ 21 , 22 ].…”

A year in review: Real world evidence, functional monitoring and emerging therapeutics in 2021

“…Health care providers and PwCF have adapted to home spirometry, remote microbiological sample collection, blood monitoring and video consultants well [ 7 , 10 , 13 ]. Advantages include less risk of cross infection and convenience for PwCF who are clinically well [ 10 , 14 , 15 ]. However, disadvantages have also been highlighted.…”

“…Over half of adults and parents/carers for PwCF express concerns about lack of in-person assessments such as lung function and microbiological testing [10] . Other disadvantages include the lack of ability to perform a physical examination, difficulties in microbiological surveillance, and the loss of subtleties in communication that may get lost without face to face contact, particularly where there is a language barrier [ 7 , [9] , [10] , [11] , [12] , [14] , [15] , [16] ]. Pediatric teams and parents have been less likely to advocate for remote consultations and have raised concerns regarding monitoring adherence, safeguarding issues, and engaging teenagers [ 8 , 9 , 12 , 14 ].…”

“…Health care delivery has evolved and there is much work to do with evaluation and implementation of new hybrid models that address the individual needs of PwCF. This will have financial implications for health care providers [ 15 , 18 ]. It will be important to include patient reported outcome measures as well as home monitoring and adherence work in these new models [ 17 , 19 ].…”