Clinician Perspectives on Telemedicine: Observational Cross-sectional Study

Abstract

Background Since the COVID-19 pandemic onset, telemedicine has increased exponentially across numerous outpatient departments and specialties. Qualitative studies examining clinician telemedicine perspectives during the pandemic identified challenges with physical examination, workflow concerns, burnout, and reduced personal connection with patients. However, these studies only included a relatively small number of physicians or were limited to a single specialty, and few assessed perspectives on integrating trainees into workflows, an important area to address to support the clinical learning environment. As telemedicine use continues, it is necessary to understand a range of clinician perspectives. Objective This study aims to survey pediatric and adult medicine clinicians at the University of Chicago Medical Center to understand their telemedicine benefits and barriers, workflow impacts, and training and support needs. Methods In July 2020, we conducted an observational cross-sectional study of University of Chicago Medical Center faculty and advanced practice providers in the Department of Medicine (DOM) and Department of Pediatrics (DOP). Results The overall response rate was 39% (200/517; DOM: 135/325, 42%; DOP: 65/192, 34%); most respondents were physicians (DOM: 100/135, 74%; DOP: 51/65, 79%). One-third took longer to prepare for (65/200, 33%) and conduct (62/200, 32%) video visits compared to in-person visits. Male clinicians reported conducting a higher percentage of telemedicine visits by video than their female counterparts (P=.02), with no differences in the number of half-days per week providing direct outpatient care or supervising trainees. Further, clinicians who conducted a higher percentage of their telemedicine by video were less likely to feel overwhelmed (P=.02), with no difference in reported burnout. Female clinicians were “more overwhelmed” with video visits compared to males (41/130, 32% vs 12/64, 19%; P=.05). Clinicians 50 years or older were “less overwhelmed” than those younger than 50 years (30/85, 35% vs 23/113, 20%; P=.02). Those who received more video visit training modalities (eg, a document and webinar on technical issues) were less likely to feel overwhelmed by the conversion to video visits (P=.007) or burnt out (P=.009). In addition, those reporting a higher ability to technically navigate a video visit were also less likely to feel overwhelmed by video visits (P=.02) or burnt out (P=.001). The top telemedicine barriers were patient-related: lack of technology access, lack of skill, and reluctance. Training needs to be focused on integrating learners into workflows. Open-ended responses highlighted a need for increased support staff. Overall, more than half “enjoyed conducting video visits” (119/200, 60%) and wanted to continue using video visits in the future (150/200, 75%). Conclusions Despite positive telemedicine experiences, more support to facilitate video visits for patients and clinicians is needed. Further, clinicians need additional training on trainee education and integration into workflows. Further work is needed to better understand why gender and age differences exist. In conclusion, interventions to address clinician and patient barriers, and enhance clinician training are needed to support telemedicine’s durability.

Provider Evaluation of a Novel Virtual Hybrid Hospital at Home Model

“…22 More than 80% of the participants agreed that ACH could provide a high quality of care to the patients, which speaks to the providers largest concern with new models of telemedicine. 13 , 14 This makes sense as one key aspect that often contributes to an enjoyable work environment is the reliability of the system one is working in. One consistent finding was the extremely high scores on the questions related to system reliability in every quarter the survey was conducted in.…”

“…Previous studies on telemedicine have shown that although providers are often accepting of the model, there are often concerns over the quality of care delivered and the long-term satisfaction with virtual care. 13 , 14 We hypothesize that healthcare providers will be accepting of the quality and safety of the virtual hybrid care model, have a positive attitude towards the decision-making and teamwork between the command center and supplier network, and find working in the ACH program rewarding. This study aims to describe the outcomes obtained from a survey applied to the ACH providers to determine their experience working with this novel virtual hybrid hospital at home program.…”

Factors Influencing How Providers Assess the Appropriateness of Video Visits: Interview Study With Primary and Specialty Health Care Providers

“…Second, specific skills and training are required to conduct effective virtual visits and spare providers from “figuring it out as [they] go.” Several efforts are underway to develop and disseminate training and instruction on virtual care and to integrate these domains into standard medical school and residency curricula [ 7 , 23 ]. Additional training resources should target mid- or later-career clinicians, since they are less likely to be exposed to interventions geared toward medical trainees.…”

“…Currently, there is a plethora of qualitative studies describing provider and patient attitudes toward virtual care, as well as perceived barriers and facilitators to virtual care implementation and adoption [2,[6][7][8]. Well-known barriers include lack of institutional support and the infrastructure to support the technology needed for virtual care, low levels of digital literacy among both patients and providers, and poor integration of virtual modalities into existing clinical workflows, to name a few [2,8,9].…”

Telemedicine for the hospitalist: Expanding telemedicine beyond outpatient and subspecialty use

“…Every hospital medicine group will likely investigate opportunities that are locally relevant and consider their unique contexts when implementing telehealth. Implementation considerations will include the clinician's openness to these technologies, 4 the populations they are serving, and what outcomes are most important. The review nicely summarizes many of the opportunities for hospital medicine programs to evaluate.…”