JMIR Publications

ABSTRACT

Background:

COVID-19 prompted safety-net healthcare systems to rapidly implement telemedicine services with little prior experience.

Objective:

To assess health system-level factors and their impact on telephone and video visit use to inform future telemedicine practices.

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 2020-July 14 2020. We conducted bivariate analyses assessing healthcare system-level factors associated with 1) Regular phone adoption (4 or more visits on average per half-day); and 2) video visit adoption (at least 1 video visit on average per half-day).

Results:

We collected 311 responses from 643 eligible clinicians, for a response rate of 48.4%. Clinician respondents (N=311) included 34.7% (N=108) primary/urgent care, 35.1% (N=109) medical, and 7.4% (N=23) surgical specialties. Our sample included 178 (57.2%) telephone adopters and 81 (26.05%) video adopters. Primary/urgent care had the highest proportion of telephone adoption (84.3%; vs. 50.4% medical, 37.5% surgical, P <0.001); medical specialties had the highest proportion of video adoption (39.1%; vs. 14.8% primary care, 12.5% % surgical, P <0.001). Among telephone adopters, 72.2% utilized personal devices for telemedicine (versus 59.0% non-regular telephone adopters, P=0.04). Video non-adopters requested more training in technical aspects than adopters (49.6% vs. 27.2%, P =0.0005).

Conclusions:

Clinical specialty type, personal device use, and desire for technical training were major factors driving telephone and video visit adoption among safety-net clinicians. Department-level support, distribution of devices, and clinician trainings are priorities for safety-net systems.