JMIR Publications

ABSTRACT

Background:

With the rapid shift to telehealth, there remains a knowledge gap in how video-based care was implemented in interdisciplinary primary care (PC) settings.

Objective:

The objective of this study is to gain an in-depth understanding regarding how video telehealth services were implemented in PC from the perspectives of patients and interdisciplinary PC team members at the Veterans Health Administration (VA) two years after the onset of the COVID-19 pandemic.

Methods:

We applied a positive and negative deviance approach and selected the 6% highest (n=8) and the 6% lowest (n=8) video utilizing PC sites in 2022 from a total of 130 VA medical centers, nationally. Twelve VA sites were included in the study, where 43 PC team members (August-October 2022) and 25 patients (February-May 2023) were interviewed. PC team members included: 16 PC providers (PCPs), 12 nurses, 3 clinical pharmacists, 3 social workers, 2 mental health specialists, 4 schedulers/clerks, and 3 leadership personnel. A diverse group of patients with respect to age, gender, race/ethnicity, and place of residence (rural/urban) were interviewed. The five domains from the Diffusion of Innovation Theory and the Non-Adoption, Abandonment, Scale-up, Spread, and Sustainability (NASSS) framework guided the development of the two study interview guides (provider, patient). We identified emerged themes/factors across all interviews that were associated with the implementation of video-based care in interdisciplinary PC settings, using directed-content rapid analysis of the interview transcripts. The analysis was guided by a priori five NASSS domains (1.patient condition/characteristic, 2.technology, 3.adopter system, 4.healthcare organization, 5.adaptation over time).

Results:

The study findings include the following common themes/factors, organized by the five NASSS domains: 1.Patient condition/characteristic: visit type/purpose (e.g., follow-up visits that do not require physical examination), health condition (e.g., homebound or semi-homebound patients), socio-demographic characteristic (e.g., patients who have long commute time); 2.Technology: key features (e.g., access to video-enabled devices), knowledge (e.g., how to use video conferencing software), technical support for patients and providers; 3.Adopter system: changes in staff roles and clinical practice (e.g., coordination of video-based care), provider and patient preference/comfort to use video-based care, caregiver’s role (e.g., participation of caregivers during video visits); 4.Healthcare organization: leadership support and access to resources, scheduling for video visit (e.g., schedule/block off virtual half/full days), trainings and telehealth champions (e.g., hands-on/on-site trainings for staff/patients/caregivers); 5.Adaptation overtime: capacity to improve all aspects of video-based care, provide continued access to resources (e.g., effective communication about updates/changes).

Conclusions:

This study identified key factors associated with the implementation of video-based services in interdisciplinary PC settings at the VA from the perspectives PC team members and patients. The identified multifaceted factors may inform recommendations on how to sustain and improve the provision of video-based care in VA PC settings, as well as non-VA patient-centered medical homes.