Care Team Perspectives and Acceptance of Telehealth in Scaling a Home-Based Primary Care Program: Qualitative Study

Abstract

Background Novel and sustainable approaches to optimizing home-based primary care (HBPC) programs are needed to meet the medical needs of a growing number of homebound older adults in the United States. Telehealth may be a viable option for scaling HBPC programs. Objective The purpose of this qualitative study was to gain insight into the perspectives of HBPC staff regarding adopting telehealth technology to increase the reach of HBPC to more homebound patients. Methods We collected qualitative data from HBPC staff (ie, physicians, registered nurses, nurse practitioners, care managers, social workers, and medical coordinators) at a practice in the New York metropolitan area through 16 semistructured interviews and three focus groups. Data were analyzed thematically using the template analysis approach with Self-Determination Theory concepts (ie, relatedness, competence, and autonomy) as an analytical lens. Results Four broad themes—pros and cons of scaling, technology impact on staff autonomy, technology impact on competence in providing care, and technology impact on the patient-caregiver-provider relationship—and multiple second-level themes emerged from the analysis. Staff acknowledged the need to scale the program without diminishing effective patient-centered care. Participants perceived alerts generated from patients and caregivers using telehealth as potentially increasing burden and necessitating a rapid response from an already busy staff while increasing ambiguity. However, they also noted that telehealth could increase efficiency and enable more informed care provision. Telehealth could enhance the patient-provider relationship by enabling caregivers to be an integral part of the patient’s care team. Staff members raised the concern that patients or caregivers might unnecessarily overutilize the technology, and that some home visits are more appropriate in person rather than via telehealth. Conclusions These findings suggest the importance of considering the perspectives of medical professionals regarding telehealth adoption. A proactive approach exploring the benefits and concerns professionals perceive in the adoption of health technology within the HBPC program will hopefully facilitate the optimal integration of telehealth innovations.

System-Wide Accelerated Implementation of Telemedicine in Response to COVID-19: Mixed Methods Evaluation

“…First, providers prefer in-person encounters to virtual ones [ 6 ]. Potential concerns include uncertainty in the clinical encounter, difficulties performing a physical examination, and concerns with the patient-provider relationship [ 7 ]. These difficulties may reduce a clinician’s motivation to deliver virtual services.…”

Toward improved homecare of frail older adults: A focus group study synthesizing patient and caregiver perspectives

“…It is noteworthy that being frail should not necessitate the loss of independent living, especially if supported by a long‐term partner 38‐40 . Our study further suggested the necessity to ensure that the technology keeping home‐living older adults in touch with physicians will help facilitate living independently rather than mitigating concerns 41 . The study underscores the shared viewpoint about the negative impact of living alone and isolation and highlights the role of social contact and home visits.…”

“…[38][39][40] Our study further suggested the necessity to ensure that the technology keeping home-living older adults in touch with physicians will help facilitate living independently rather than mitigating concerns. 41 The study underscores the shared viewpoint about the negative impact of living alone and isolation and highlights the role of social contact and home visits. Social isolation and the loneliness feeling are known risk factors for frailty and associated adverse outcomes.…”

Home‐based primary care: A systematic review of the literature, 2010–2020

“…Qualitative research by Kozikowski et al revealed that providers felt technology could broaden the reach and increase the amount of patient contact in HBPC practices, at the risk of de‐personalizing care. Providers also worried about monitoring multiple communication channels 76 . Technology was successfully harnessed using a number of models for provision of mental health services for individual and group therapy 30,34,75 …”

“…Six studies 73–78 focused on technology—particularly telehealth—as a way to extend the reach of HBPC. Dang and colleagues reported that 76% of surveyed VHA HBPC practices used remote biometric monitoring and messaging devices.…”