JMIR Publications

ABSTRACT

Background:

Though telehealth is a promising approach for removing barriers to care and improving access for patients, there has been a drastic decrease in utilization following the initial rise during the acute COVID-19 public health crisis. Understanding the barriers and facilitators to maintenance of virtual visits—one key component of telehealth—is critical for ensuring this service is sustained.

Objective:

To describe providers’ perceived barriers and facilitators to continued use of virtual visits.

Methods:

We performed a qualitative content analysis of free-text responses from a survey of providers administered from February 5-14, 2021 at a large, midwestern academic institution. This population-based sample included all providers from professions that offered telehealth (e.g., physicians, nurse educators, physical therapists) who completed at least one virtual visit from March 20, 2020-February 14, 2021. The primary outcome was experience providing virtual visits, including barriers and facilitators to continued utilization of virtual visits. Survey questions included three major domains: quality of care, technology, and satisfaction. Responses were coded using a qualitative content analysis and further analyzed through a matrix analysis to understand providers’ perspectives and elucidate key barriers and facilitators of virtual visit utilization.

Results:

Of 2692 eligible providers, 1040 (38.6%) completed the survey. These providers spanned seven healthcare professions and 47 clinical departments. The most common professions represented were physicians (n=486, 46.7%), residents/fellows (n=85, 8.2%), and nurse practitioners (n=81, 7.8%), while the most common clinical departments were Internal Medicine (n=69, 6.6%), Psychiatry (n=69, 6.6%), and Physical Medicine and Rehabilitation (n=67, 6.4%). Four overarching categories of provider experience with virtual visits emerged: quality of care, patient rapport, visit flow, and equity. Though many providers saw virtual visits as a tool for improving care access, quality, and equity, others shared how appropriate selection of virtual visits, support (e.g., patient training, home devices, broadband access), and telehealth policy (e.g., relaxation of licensing requirements across state borders, reimbursement for phone-only modalities), needed optimization to sustain virtual visits.

Conclusions:

Our findings demonstrate key barriers to maintenance of telehealth services following the acute public health crisis. These findings can help prioritize the most impactful methods of sustaining and expanding telehealth availability.