JMIR Publications

ABSTRACT

Background:

The rapid implementation of virtual care (i.e., telephone or video-based clinic appointments) during the COVID-19 pandemic resulted in many providers offering virtual care with little or no formal training and without clinical guidelines and tools to assist with decision-making. As new guidelines and tools take shape, it is critical that they are informed by an in-depth understanding of how providers make decisions about virtual care in their clinical practices.

Objective:

We sought to identify the most salient factors that influence how providers make decisions about when to offer patients video or telephone appointments instead of or in conjunction with in-person care.

Methods:

We conducted semi-structured interviews with 28 healthcare providers located at the Veterans Health Administration (VA). We used an inductive, thematic approach to identify factors that impact provider decision-making.

Results:

Thematic analysis revealed distinct clinical, patient, and provider factors that influence provider decisions to initiate or continue with virtual visits. Clinical factors include patient acuity, the need for additional tests or labs, changes in patients’ health status, and if the patient is new or has no recent visit. Patient factors include patients’ ability to articulate symptoms or needs, availability and accessibility of technology, preferences for or against virtual visits, and access to caregiver assistance. Provider factors include provider comfort with and acceptance of virtual technology, and virtual physical exam skills and training.

Conclusions:

Providers within the VA system consider a complex set of factors when deciding whether to offer or continue a video or telephone visit. These factors can inform the creation of decision tools, guides, and other policies to ensure that virtual care expands access to high-quality care. Clinical Trial: N/A