Parent Perspectives on Family-Centered Pediatric Electronic Consultations: Qualitative Study

Verma, Rhea; Krishnamurti, Tamar; Ray, Kristin N.

doi:10.2196/16954

Cited by 11 publications

(17 citation statements)

References 20 publications

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“…In contrast, participants in prior studies expressed concern that information might be lost in the direct PCP-specialist communication, particularly if the PCP was not perceived to be taking certain symptoms seriously. 28,30,31 Participants in another pediatric study also voiced apprehension about data confidentiality, 31 fearful that information might "get into the wrong hands." Caregivers in this study did not express either of these concerns.…”

Section: Discussionmentioning

confidence: 99%

“…They also expressed frustration about the long wait times to access specialty care, and valued being able to receive prompt advice or an expedited appointment if needed through the ECR system. Frustration over long wait times to access specialty care is a common theme 27,28,31 and highlights one of the major benefits of electronic consultation. As the demand for specialty care increases, particularly in pediatrics, there is an increasing need for developing alternative systems to access specialty care quickly.…”

Section: Discussionmentioning

confidence: 99%

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Understanding Caregiver Perspectives on an Electronic Consultation and Referral System

Rea

Toomey

Rosen

et al. 2022

Clin Pediatr (Phila)

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This study examined caregiver impressions of an electronic consultation and referral (ECR) system. Participants included 56 caregivers of primary care patients referred through the ECR system. Semistructured interviews and surveys were conducted between August 2018 and April 2019. Transcripts were coded and themes developed using thematic content analysis. A total of 51% of caregivers stated that they would prefer to see their child’s primary care provider (PCP) for a specialty issue if they could receive the same quality of care. All caregivers who received an electronic consult (n = 28) said that they would utilize that process again. Three themes emerged: (1) caregivers expect immediate action prior to or instead of a specialty referral; (2) caregiver preferences for PCP versus specialist are mediated by both child and provider characteristics; (3) caregiver attitudes toward the ECR system are influenced by external considerations and experiences with the system. Results suggest caregivers value enhanced communication and immediate access to specialty input facilitated by the ECR system.

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Section: Discussionmentioning

confidence: 99%

Section: Discussionmentioning

confidence: 99%

Understanding Caregiver Perspectives on an Electronic Consultation and Referral System

Rea

Toomey

Rosen

et al. 2022

Clin Pediatr (Phila)

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“…Finally, we did not include AYAs or caregivers in the design process. Both groups may have additional preferences regarding system design, as evidenced by work with pediatric patients and caregivers [ 36 , 37 ], such that additional work specifically with AYAs and AYA caregivers is warranted.…”

Section: Discussionmentioning

confidence: 99%

Optimizing e-Consultations to Adolescent Medicine Specialists: Qualitative Synthesis of Feedback From User-Centered Design

Rankine¹,

Yeramosu²,

Matheo³

et al. 2021

JMIR Hum Factors

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Background e-Consultations between primary care physicians and specialists are a valuable means of improving access to specialty care. Adolescents and young adults (AYAs) face unique challenges in accessing limited adolescent medicine specialty care resources, which contributes to delayed or forgone care. e-Consultations between general pediatricians and adolescent medicine specialists may alleviate these barriers to care. However, the optimal application of this model in adolescent medicine requires careful attention to the nuances of AYA care. Objective This study aims to qualitatively analyze feedback obtained during the iterative development of an e-consultation system for communication between general pediatricians and adolescent medicine specialists tailored to the specific health care needs of AYAs. Methods We conducted an iterative user-centered design and evaluation process in two phases. In the first phase, we created a static e-consultation prototype and storyboards and evaluated them with target users (general pediatricians and adolescent medicine specialists). In the second phase, we incorporated feedback to develop a functional prototype within the electronic health record and again evaluated this with general pediatricians and adolescent medicine specialists. In each phase, general pediatricians and adolescent medicine specialists provided think-aloud feedback during the use of the prototypes and semistructured exit interviews, which was qualitatively analyzed to identify perspectives related to the usefulness and usability of the e-consultation system. Results Both general pediatricians (n=12) and adolescent medicine specialists (n=12) perceived the usefulness of e-consultations for AYA patients, with more varied perceptions of potential usefulness for generalist and adolescent medicine clinicians. General pediatricians and adolescent medicine specialists discussed ways to maximize the usability of e-consultations for AYAs, primarily by improving efficiency (eg, reducing documentation, emphasizing critical information, using autopopulated data fields, and balancing specificity and efficiency through text prompts) and reducing the potential for errors (eg, prompting a review of autopopulated data fields, requiring physician contact information, and prompting explicit discussion of patient communication and confidentiality expectations). Through iterative design, patient history documentation was streamlined, whereas documentation of communication and confidentiality expectations were enhanced. Conclusions Through an iterative user-centered design process, we identified user perspectives to guide the refinement of an e-consultation system based on general pediatrician and adolescent medicine specialist feedback on usefulness and usability related to the care of AYAs. Qualitative analysis of this feedback revealed both opportunities and risks related to confidentiality, communication, and the use of tailored documentation prompts that should be considered in the development and use of e-consultations with AYAs.

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“…All the HTH visits were conducted in 2017, and billing data collection was completed in 2018, therefore our outcomes may not be representative of the current regulatory environment, which is rapidly evolving in California and across the United States. 11 However, given the trend toward more coverage of HTH and the lasting effects of the COVID-19 pandemic, the effect of this limitation may not be significant. There were no Medicare patients in our study, so it would be difficult to extrapolate our results to that patient population.…”

Section: Discussionmentioning

confidence: 99%

“…5 Additional concerns relating to consent, privacy, and participation of the parent-child dyad have also made telehealth adoption slower in pediatrics than in adult care. 11 Concerns regarding reimbursement remain a major barrier for telehealth adoption, with some states and payers reimbursing less for telehealth than in-person visits or not at all. 12 The location of the patient also affects whether the visit is reimbursed.…”

Section: Introductionmentioning

confidence: 99%

Reimbursement patterns and user experiences in pediatric allergy home telehealth

Mehta

Braskett

Tam

et al. 2020

Annals of Allergy, Asthma & Immunology

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Background: Telehealth use has been increasing during the last decade. Studies have found that patients have a positive attitude toward incorporating telehealth into their health care. Substantial uncertainty remains regarding reimbursement policies that vary widely between states and by payer. Objective: To explore the clinical, operational, and financial feasibility of a home telehealth (HTH) program in a pediatric allergy and immunology clinic. Methods: Allergy and immunology physicians defined use cases they deemed appropriate for HTH appointments. Established patients in the allergy and immunology clinic were approached to complete an attitudes and perception survey. Patients who met the use case definitions were asked to participate in the pilot program. After their HTH appointment took place, they completed a validated satisfaction survey. Our institution's revenue cycle management team provided reimbursement data. Results: Patient attitudes toward HTH were generally favorable. A total of 51 HTH appointments were offered, and 46 appointments were made. Notably, 37 appointments were completed successfully among 32 unique patients. Patients were satisfied with the HTH experience. A total of 36 of 37 encounters were reimbursed by 19 different public and private payers. Payers on average reimbursed AE6% of the expected allowable for an equivalent in-person visit. Conclusion:Patients had reservations about HTH initially but were satisfied with their experience. Private and public payers reimbursed HTH the same as in-person appointments. Here, we report that HTH is well accepted by patients and is financially viable.

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Parent Perspectives on Family-Centered Pediatric Electronic Consultations: Qualitative Study

Cited by 11 publications

References 20 publications

Understanding Caregiver Perspectives on an Electronic Consultation and Referral System

Understanding Caregiver Perspectives on an Electronic Consultation and Referral System

Optimizing e-Consultations to Adolescent Medicine Specialists: Qualitative Synthesis of Feedback From User-Centered Design

Reimbursement patterns and user experiences in pediatric allergy home telehealth

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