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

Abstract

Background The rapid implementation of virtual care (ie, telephone or video-based clinic appointments) during the COVID-19 pandemic resulted in many providers offering virtual care with little or no formal training and without clinical guidelines and tools to assist with decision-making. As new guidelines for virtual care provision take shape, it is critical that they are informed by an in-depth understanding of how providers make decisions about virtual care in their clinical practices. Objective In this paper, we sought to identify the most salient factors that influence how providers decide when to offer patients video appointments instead of or in conjunction with in-person care. Methods We conducted semistructured interviews with 28 purposefully selected primary and specialty health care providers from the US Department of Veteran’s Affairs health care system. We used an inductive approach to identify factors that impact provider decision-making. Results Qualitative analysis revealed distinct clinical, patient, and provider factors that influence provider decisions to initiate or continue with virtual visits. Clinical factors include patient acuity, the need for additional tests or labs, changes in patients’ health status, and whether the patient is new or has no recent visit. Patient factors include patients’ ability to articulate symptoms or needs, availability and accessibility of technology, preferences for or against virtual visits, and access to caregiver assistance. Provider factors include provider comfort with and acceptance of virtual technology as well as virtual physical exam skills and training. Conclusions Providers within the US Department of Veterans Affairs health administration system consider a complex set of factors when deciding whether to offer or continue a video or telephone visit. These factors can inform the development and further refinement of decision tools, guides, and other policies to ensure that virtual care expands access to high-quality care.

Factors that influence the uptake of virtual care solutions in Australian primary care practice: a systematic scoping review

“…This suggests the modality was not clinically suitable for certain patients. While determining patient suitability for different virtual care innovations is a complex process [26, 35,50] the re nement of guidelines for clinicians concerning patient suitability for various virtual care modalities may encourage proper implementation in primary healthcare while improving clinical outcomes and patient experience [51]. In a primary mental health care setting where clinicians considered the clinical appropriateness of patients for participation in a virtually administered mental health care program, clinical risk was averted, and implementation facilitated [13], demonstrating that having a benchmark to ascertain patient compatibility with virtual care may be bene cial.…”

Opportunities to Enhance the Implementation of Veterans Affairs Video-Based Care: Qualitative Perspectives of Providers from Diverse Specialties

“…We used a combination of administrative data and provider referrals to purposefully sample 28 providers [ 29 ], ranging in specialties from primary care (n=11), cardiology (n=7), palliative care (n=5), and spinal cord injury (n=5). These specialties were identified to represent a diverse set of clinical care and services that can be offered during a video visit [ 30 ]. Primary care addresses a patient’s medical, social, and behavioral needs through history-taking, physical examinations, laboratories, imaging, and medication management [ 31 ]; cardiology care focuses on a patient’s cardiac conditions and offers specialized procedures [ 32 ]; palliative care typically centers around in-depth goals of care discussions and medication management near the end of life [ 33 ]; and spinal cord injury care provides comprehensive education, counseling, coordination, and ongoing monitoring for a highly complex chronic condition [ 34 ].…”

Medical specialists’ use and opinion of video consultation in Denmark: a survey study

“…International studies have primarily investigated video consultation in the context of general practitioners (GP), ambulatories, and hospitals, and prior findings in terms of effectiveness and accessibility to care are largely positive although technological challenges are continuously highlighted [ 3 – 5 ]. Successful use depends on patients’ and clinicians’ willingness and acceptance towards new technologies, technological training and support as well as patients’ specific medical conditions [ 2 – 4 , 6 ]. Clinicians appreciate greater flexibility and saved time for their patients.…”

“…Thus, it is crucial for specialists to have optimal conditions for their medical practice in their clinical encounter. Studies exploring the use of video consultation in medical specialists’ practice have shown that the use of video consultation for patients with chronic diseases [ 6 ] and in follow-up consultations [ 10 ] can be appropriate. Within psychiatry, a review showed that video consultation for elderly patients with depression worked well [ 11 ], while another study based on the perspective of psychiatrists highlighted that handling certain topics such as traumatic incidents was not appropriate by video [ 12 ].…”