JMIR Publications

ABSTRACT

Background:

Veteran Affairs healthcare systems have been early adopters of asynchronous telemedicine to provide access to timely and high-quality specialty care services in primary care settings for veterans living in rural areas. Scant research has examined how to expand primary care team members’ engagement in tele-specialty care.

Objective:

This qualitative study aimed to explore implementation process barriers and facilitators to using asynchronous tele-specialty care (i.e., tele-dermatology and tele-eye care services).

Methods:

Thirty participants including primary care providers, nurses, telehealth clinical technicians, medical and program support assistants, and administrators from two community-based outpatient clinics were interviewed. Semi-structured interviews were conducted using an interview guide, digitally recorded and transcribed. Interview transcripts were analyzed using a qualitative content analysis summative approach. Two coders reviewed transcripts independently. Discrepancies were resolved by consensus discussion.

Results:

Three themes were identified from participants’ experiences: positive perception of tele-specialty care, concerns and challenges of implementation, and suggestions for service refinement. Participants voiced that the telemedicine visits save commute and waiting times and provided veterans in rural areas more access to timely medical care. Tele-specialty visits also allow the flexibility for providers to read charts remotely and broaden their clinical care coverage. Mentioned concerns were technical challenges and equipment failure, staffing shortages to cover both in person and telehealth visit needs, overbooked schedules leading to delayed referral, and needs for a more standardized operation protocol and more hands-on training with formative feedback among supporting staff. Participants also faced challenges with appointment no shows and last-minute cancellations and struggled to find ways to efficiently manage both virtual and in-person visits to streamline patient flow. Nonetheless, most participants feel motivated and confident of implementing tele-specialty care going forward.

Conclusions:

This study provided important insights on the positive perceptions and ongoing challenges in tele-specialty care implementation. Feedback from primary care teams is required to improve tele-specialty care service delivery for rural veterans.