JMIR Publications

ABSTRACT

Background:

Background:

COVID-19 prompted safety-net healthcare 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:

Objectives: 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:

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) 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:

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%) high telephone adopters and 81 (26.05%) video adopters. Among high telephone adopters, 72.2% utilized personal devices for telemedicine (versus 59.0% low telephone adopters, P=.04). Video non-adopters requested more training in technical aspects than adopters (49.6% vs. 27.2%, P =.0005). Primary/urgent care had the highest proportion of high telephone adoption (84.3%; vs. 50.4% medical, 37.5% surgical, P <.001); medical specialties had the highest proportion of video adoption (39.1%; vs. 14.8% primary care, 12.5% surgical, P <.001).

Conclusions:

Conclusions:

Personal device use, and desire for technical training, and department specialty were major factors driving high telephone and video visit adoption among safety-net clinicians. Secure device access, clinician technical trainings, and department-wide assessments are priorities for safety-net systems.