JMIR Publications

ABSTRACT

Background:

Prevalence of telehealth video use across the United States is uneven, with low uptake in safety-net health care delivery systems, which care for patient populations who face barriers to use of digital technologies.

Objective:

To increase video visit use in an urban safety-net delivery system, we piloted a Telehealth Ambassador program in which volunteers provided technical support to patients to participate in video visits rather than audio-only visits.

Methods:

The RE-AIM framework was used for program evaluation. Reach was quantified by the percentage of eligible patients who answered calls from Telehealth Ambassadors. Program efficacy was calculated in several ways: (1) percentage of interested patients with video visit capability who were successfully onboarded; (2) percentage of onboarded patients who completed their scheduled video visits; and (3) percentage of patients reached who completed their scheduled video visit regardless of interest and capability. A structured telephone survey was used to ascertain barriers to completion of telehealth video visits.

Results:

Between March and May 2021, Telehealth Ambassadors attempted to contact 776 eligible patients; 43.6% (n=338/776) were reached by phone, among whom 44.4% (n=150/338) voiced interest in video-visits and were provided digital support. Mean call duration was 8.8 (range 0-35) minutes. Over 67.3% (n=101/150) of patients who received support successfully completed a telehealth video visit with their provider, which translated into a 30.0% video visit completion rate among eligible patients reached by phone (n=101/338) and 13.0% (n=101/776) among all eligible patients. Among patients who were contacted but declined video visit digital support, 42% did not see added value beyond a telehealth audio-only visit, 20% had insufficient internet access and 27% declined learning about a new technology.

Conclusions:

Increasing the program’s reach will require outreach solutions that do not rely solely on phone calls. Routinely highlighting the benefits of video visits and partnering with community-based organizations to overcome structural barriers to telehealth use will help increase the program’s efficacy.