Clinician Experience with Telemedicine at a Safety-net Hospital Network during COVID-19: A Cross-sectional Survey

Sharma, Anjana E.; Khoong, Elaine C.; Nijagal, Malini A.; Lyles, Courtney R.; Su, George; DeFries, Triveni; Sarkar, Urmimala; Tuot, Delphine S.

doi:10.1353/hpu.2021.0060

Cited by 15 publications

(10 citation statements)

References 42 publications

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“…Notably, our sample included patients who primarily had public insurance (n=88, 69%) and had greater racial diversity (n=48, 37% Black, n=42, 33% White) compared to the prior study where patients primarily had private insurance (65.2%) and were largely White (77.5%) [ 28 ]. A recent survey of providers in a safety net hospital in a non–mental health setting showed results consistent with our study [ 29 ]. These providers reported that most visits were conducted over the telephone due to patient preference, with technological problems and digital literacy being the most common barriers to video visits [ 29 ].…”

Section: Discussionsupporting

confidence: 91%

“…Our main finding that 61.7% (n=79) of patients preferred video-based visits through the hospital’s patient portal to phone visits is lower than a similar survey during the COVID-19 pandemic of patients in a large hospital-based psychiatry clinic that found 82.8% of patients chose video-based visits through a patient portal [ 28 ]. The differences in preference for video-based visits over phone visits could be related to demographic differences between clinics that may reflect access to technology, clinic workflow, or other structural influences [ 29 ]. Notably, our sample included patients who primarily had public insurance (n=88, 69%) and had greater racial diversity (n=48, 37% Black, n=42, 33% White) compared to the prior study where patients primarily had private insurance (65.2%) and were largely White (77.5%) [ 28 ].…”

Section: Discussionmentioning

confidence: 99%

“…These providers reported that most visits were conducted over the telephone due to patient preference, with technological problems and digital literacy being the most common barriers to video visits [ 29 ]. Given the importance of video-based visits through patient portals for delivering safe [ 29 ], high-quality psychiatric care, increased research with demographically diverse patient samples is needed to identify what barriers may be leading to decreased preference for this type of telepsychiatry visit.…”

Section: Discussionmentioning

confidence: 99%

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Patient Preferences for Patient Portal–Based Telepsychiatry in a Safety Net Hospital Setting During COVID-19: Cross-sectional Study

Yue¹,

Mail²,

DiSalvo³

et al. 2022

JMIR Form Res

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Background Patient portals are a safe and secure way for patients to connect with providers for video-based telepsychiatry and help to overcome the financial and logistical barriers associated with face-to-face mental health care. Due to the COVID-19 pandemic, telepsychiatry has become increasingly important to obtaining mental health care. However, financial and technological barriers, termed the “digital divide,” prevent some patients from accessing the technology needed to use telepsychiatry services. Objective As an extension to a clinic’s outreach project during COVID-19 to improve patient engagement with video-based visits through the hospital’s patient portal among adult behavioral health patients at an urban safety net hospital, we aim to assess patient preference for patient portal–based video visits or telephone-only visits and to identify the demographic variables associated with their preference. Methods Patients in an outpatient psychiatry clinic were contacted by phone, and preference for telepsychiatry by phone or video through a patient portal, as well as device preference for video-based visits, were documented. Patient demographic characteristics were collected from the electronic medical record. Results A total of 128 patients were reached by phone. A total of 79 (61.7%) patients chose video-based visits, and 69.6% (n=55) of these patients preferred to access the patient portal through a smartphone. Older patients were significantly less likely to agree to video-based visits. Conclusions Among behavioral health patients at a safety net hospital, there was relatively low engagement with video-based visits through the hospital’s patient portal, particularly among older adults.

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Section: Discussionsupporting

confidence: 91%

Section: Discussionmentioning

confidence: 99%

Section: Discussionmentioning

confidence: 99%

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Patient Preferences for Patient Portal–Based Telepsychiatry in a Safety Net Hospital Setting During COVID-19: Cross-sectional Study

Yue¹,

Mail²,

DiSalvo³

et al. 2022

JMIR Form Res

View full text Add to dashboard Cite

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“…Neither perceived workload of telemedicine (compared to in-person care), nor length of time spent supporting a patient to enter a telemedicine visit were associated with telemedicine adoption. Interpreter challenges were not associated with adoption, although this has been endorsed as a barrier by clinicians [ 33 ]. Although safety-net patients may experience access barriers to bandwidth or adequate audio, audio quality was not associated with telemedicine adoption.…”

Section: Discussionmentioning

confidence: 99%

System-Level Factors Associated With Telephone and Video Visit Use: Survey of Safety-Net Clinicians During the Early Phase of the COVID-19 Pandemic

Sharma¹,

Khoong²,

Sieera³

et al. 2022

JMIR Form Res

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Background The COVID-19 pandemic prompted safety-net health care systems to rapidly implement telemedicine services with little prior experience, causing disparities in access to virtual visits. While much attention has been given to patient barriers, less is known regarding system-level factors influencing telephone versus video-visit adoption. As telemedicine remains a preferred service for patients and providers, and reimbursement parity will not continue for audio visits, health systems must evaluate how to support higher-quality video visit access. Objective This study aimed to assess health system–level factors and their impact on telephone and video visit adoption to inform sustainability of telemedicine for ambulatory safety-net sites. Methods We conducted a cross-sectional survey among ambulatory care clinicians at a hospital-linked ambulatory clinic network serving a diverse, publicly insured patient population between May 28 and July 14, 2020. We conducted bivariate analyses assessing health care system–level factors associated with (1) high telephone adoption (4 or more visits on average per session); and (2) video visit adoption (at least 1 video visit on average per session). Results We collected 311 responses from 643 eligible clinicians, yielding a response rate of 48.4%. Clinician respondents (N=311) included 34.7% (n=108) primary or urgent care, 35.1% (n=109) medical, and 7.4% (n=23) surgical specialties. Our sample included 178 (57.2%) high telephone adopters and 81 (26.05%) video adopters. Among high telephone adopters, 72.2% utilized personal devices for telemedicine (vs 59.0% of low telephone adopters, P=.04). Video nonadopters requested more training in technical aspects than adopters (49.6% vs 27.2%, P<.001). Primary or urgent care had the highest proportion of high telephone adoption (84.3%, compared to 50.4% of medical and 37.5% of surgical specialties, P<.001). Medical specialties had the highest proportion of video adoption (39.1%, compared to 14.8% of primary care and 12.5% of surgical specialties, P<.001). Conclusions Personal device access and department specialty were major factors associated with high telephone and video visit adoption among safety-net clinicians. Desire for training was associated with lower video visit use. Secure device access, clinician technical trainings, and department-wide assessments are priorities for safety-net systems implementing telemedicine.

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“…10 In a recent study, clinicians expressed concern about diagnostic safety in telemedicine encounters. 11 This largely results from a reduced ability to collect information to formulate an accurate diagnosis.…”

Section: Potential Impact On Diagnostic Errorsmentioning

confidence: 99%

The Abrupt Expansion of Ambulatory Telemedicine: Implications for Patient Safety

et al. 2022

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The exponential growth of telemedicine in ambulatory care triggered by the COVID-19 public health emergency has undoubtedly impacted the quality of care and patient safety. In particular, the increased adoption of remote care has impacted communication, care teams, and patient engagement, which are key factors that impact patient safety in ambulatory care. In this perspective, we draw on a scoping review of the literature, our own clinical experiences, and conversations with patient safety experts to describe how changes in communication, care teams, and patient engagement have impacted two high priority areas in ambulatory safety: diagnostic errors and medication safety. We then provide recommendations for research funders, researchers, healthcare systems, policy makers, and healthcare payors for how to improve patient safety in telemedicine based on what is currently known as well as next steps for how to advance understanding of the safety implications of telemedicine utilization.

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Clinician Experience with Telemedicine at a Safety-net Hospital Network during COVID-19: A Cross-sectional Survey

Cited by 15 publications

References 42 publications

Patient Preferences for Patient Portal–Based Telepsychiatry in a Safety Net Hospital Setting During COVID-19: Cross-sectional Study

Patient Preferences for Patient Portal–Based Telepsychiatry in a Safety Net Hospital Setting During COVID-19: Cross-sectional Study

System-Level Factors Associated With Telephone and Video Visit Use: Survey of Safety-Net Clinicians During the Early Phase of the COVID-19 Pandemic

The Abrupt Expansion of Ambulatory Telemedicine: Implications for Patient Safety

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