Scheduled telephone visits in the veterans health administration patient-centered medical home

Abstract

BackgroundThe Veterans Health Administration (VHA) patient-centered medical home model, Patient Aligned Care Teams (PACT), includes telephone visits to improve care access and efficiency. Scheduled telephone visits can replace in-person care for some focused issues, and more information is needed to understand how this mode can best work for primary care. We conducted a study at the beginning of PACT implementation to elicit stakeholder views on this mode of healthcare delivery, including potential facilitators and barriers.MethodsWe conducted focus groups with primary care patients (n = 3 groups), providers (n = 2 groups) and staff (n = 2 groups). Questions were informed by Donabedian’s framework to evaluate and improve healthcare quality. Content analysis and theme matrix techniques were used to explore themes. Content was assigned a positive or negative valuation to indicate whether it was a facilitator or barrier. PACT principles were used as an organizing framework to present stakeholder responses within the context of the VHA patient-centered medical home program.ResultsScheduled telephone visits could potentially improve care quality and efficiency, but stakeholders were cautious. Themes were identified relating to the following PACT principles: comprehensiveness, patient-centeredness, and continuity of care. In sum, scheduled telephone visits were viewed as potentially beneficial for routine care not requiring physical examination, and patients and providers suggested using them to evaluate need for in-person care; however, visits would need to be individualized, with patients able to discontinue if not satisfied. Patients and staff asserted that providers would need to be kept in the loop for continuity of care. Additionally, providers and staff emphasized needing protected time for these calls.ConclusionThese findings inform development of scheduled telephone visits as part of patient-centered medical homes by providing evidence about areas that may be leveraged to most effectively implement this mode of care. Presenting this service as enhanced care, with ability to triage need for in-person clinic visits and consequently provide more frequent contact, may most adequately meet different stakeholder expectations. In this way, scheduled telephone visits may serve as both a substitute for in-person care for certain situations and a supplement to in-person interaction.

The Effects of Telephone Visits and Rurality on Veterans Perceptions of Access to Primary Care

“…While not focused specifically on rural, another study conducted in the VHA found favorable perceptions of telephone visits for routine care not requiring a physical from both Veterans and primary care providers. 3 Relatedly, McKinstry et al 6 found that telephone consultations were often used by rural patients and staff to maintain more regular contact and to avoid having to travel. They also reported that, unlike urban patients, rural patients were more likely to use telephone consultations to determine whether an in-person visit was necessary.…”

“…1 The use of telephone visits is 1 strategy being promoted to enhance access to primary care that does not require in-person visits. 2,3 A recent study from the Veterans Health Administration (VHA) found that the use of telephone communication is strongly associated with higher patient perceptions of access. 4 To our knowledge, no studies have specifically examined rural patients' perceptions of access associated with telephone visits, especially for clinics with longer wait times for in-person visits.…”

Introducing Primary Care Telephone Visits: An Urban Safety-Net Community Clinic Experience

“… 6 Focus groups performed before the implementation of scheduled telephone visits at the Veteran’s Administration primary care clinics found that patients viewed them as potentially beneficial for routine care but feared losing touch with their providers. 7 …”

Innovative Strategies for Nurse Practitioner Student Engagement in Alternative Patient Visits

“…Novice NPs may enter practice lacking the skills and confidence to interpret and effectively communicate laboratory results and to return patient telephone calls. Providing more venues that improve access to care, such as through telephone visits, is integral in meeting the needs of patients (Adler-Milstein, Kvedar, & Bates, 2014;Sperber et al, 2014). Telephone visits also can be used for lifestyle modification counseling and episodic or nonurgent visits not requiring a physical examination (Kyanko et al, 2018).…”