Not Yet Ready for Prime Time: Video Visits in a Home‐Based Primary Care Program

Latus-Olaifa, Olushola; Norman, Gregory J.; Kurliand, Michael M; Slaboda, Jill C.; Abrashkin, Karen A.; Smith, Kristofer L.; Pekmezaris, Renée; Rhodes, Karin V.

doi:10.1111/jgs.16064

Cited by 18 publications

(13 citation statements)

References 8 publications

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“…The COVID-19 pandemic has transformed the way health care is delivered, with various sectors providing more care through technology. Emerging evidence has documented physician views about the challenges of rapidly implementing telemedicine [28][29][30][31]. A survey among nephrologists reported increased access for patients, but concerns with proper physical examination, monitoring, and education of patients.…”

Section: Principal Findingsmentioning

confidence: 99%

Implementing a Virtual Emergency Department: Qualitative Study Using the Normalization Process Theory

Shuldiner¹,

Srinivasan²,

Hall³

et al. 2022

JMIR Hum Factors

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Background COVID-19 necessitated the rapid implementation and uptake of virtual health care; however, virtual care’s potential role remains unclear in the urgent care setting. In December 2020, the first virtual emergency department (ED) in the Greater Toronto Area was piloted at Sunnybrook Health Sciences Centre by connecting patients to emergency physicians through an online portal. Objective This study aims to understand whether and how ED physicians were able to integrate a virtual ED alongside in-person operations. Methods We conducted semistructured interviews with ED physicians guided by the Normalization Process Theory (NPT). The NPT provides a framework to understand how individuals and teams navigate the process of embedding new models of care as part of normal practice. All physicians who had worked within the virtual ED model were invited to participate. Data were analyzed using a combination of inductive and deductive techniques informed by the NPT. Results A total of 14 physicians were interviewed. Participant experiences were categorized into 1 of 2 groups: 1 group moved to normalize the virtual ED in practice, while the other described barriers to routine adoption. These groups differed in their perception of the patient benefits as well as the perceived role in the virtual ED. The group that normalized the virtual ED model saw value for patients (coherence) and was motivated by patient satisfaction witnessed (reflexive monitoring) at the end of the virtual appointment. By contrast, the other group did not find virtual ED work reflective of the perceived role of urgent care (cognitive participation) and felt their skills as ED physicians were underutilized. The limited ability to examine patients and a sense that patient issues were not fully resolved at the end of the virtual appointment caused frustration among the second group. Conclusions As further digital integration within the health care system occurs, it will be essential to support the evolution of staff skill sets to ensure physicians are satisfied with the care they are providing to their patients, while also ensuring the technology and process are efficient.

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Section: Principal Findingsmentioning

confidence: 99%

Implementing a Virtual Emergency Department: Qualitative Study Using the Normalization Process Theory

Shuldiner¹,

Srinivasan²,

Hall³

et al. 2022

JMIR Hum Factors

View full text Add to dashboard Cite

show abstract

“…During video encounters, HBPC physicians can examine a wound, visually review patients’ medications, or view home conditions that might interfere with patients’ health and well-being. However, there are potential limitations, including concerns over access, technical and administrative challenges, and limits to what can be seen through a video screen (Kim et al, 2019; Kozikowski et al, 2019; Latus-Olaifa et al, 2019). Access challenges in particular may be important for homebound patients, who commonly have limited incomes and may not have access to the necessary technology, such as a smartphone or broadband service (Abrashkin et al, 2020; Kalicki et al, 2021).…”

Section: Introductionmentioning

confidence: 99%

“There Is Something Very Personal About Seeing Someone’s Face”: Provider Perceptions of Video Visits in Home-Based Primary Care During COVID-19

et al. 2021

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The rapid deployment of video visits during COVID-19 may have posed unique challenges for home-based primary care (HBPC) practices due to their hands-on model of care and older adult population. This qualitative study examined provider perceptions of video visits during the first wave of the COVID-19 crisis in New York City (NYC) through interviews with HBPC clinical/medical directors, program managers, nurse practitioners/nurse managers, and social work managers ( n = 13) at six NYC-area practices. Providers reported a combination of commercial (health system-supported) and consumer (e.g., FaceTime) technological platforms was essential. Video visit benefits included triaging patient needs, collecting patient information, and increasing scheduling capacity. Barriers included cognitive and sensory abilities, technology access, reliance on caregivers and aides, addressing sensitive topics, and incomplete exams. Effectively integrating video visits requires considering how technology can be proactively integrated into practice. A policy that promotes platform flexibility will be crucial in fostering video integration.

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“…This is in keeping with previously reported findings amongst patients of all ages and is explained by the relative ease of use and technological availability of phone visits compared to that required for videoconferences, as we have also identified in our study. ( 20 )…”

Section: Discussionmentioning

confidence: 99%

Personalized Telehealth: Redesigning Complex Care Delivery for the 65+ During the COVID Pandemic: a Survey of Patients, Caregivers, and Health-care Providers

et al. 2023

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Background In the context of the ongoing COVID-19 pandemic, rapid transitions have been made towards telehealth. Optimal use of telehealth in elderly patients remains poorly understood and adaptation challenges persist. Our study aimed at identifying perceptions, barriers, and possible facilitators to telehealth use amongst elderly patients with comorbidities, their caregivers, and health-care providers (HCPs). Methods Health-care providers, patients 65 years and older with multiple comorbidities, and caregivers were recruited from outpatient clinics and invited to complete an electronic self-administered or telephone-administered survey on their perceptions of telehealth and of barriers to its implementation. Results A total of 39 health-care providers, 40 patients, and 22 care-givers responded to the survey. Most patients (90%), caregivers (82%), and HCPs (97%) had experienced telephone visits, but few were conducted via videoconference platforms. Patients and caregivers showed interest in pursuing some future telehealth visits (68%, 86%, respectively), but felt they lacked access to technology and skills (n=8, 20%), and some felt that telehealth visits may be inferior to in-person visits (n=9, 23%). HCPs showed interest in incorporating telehealth visits into practice (n=32, 82%), but identified challenges in lack of administrative support (n=37), lack of HCP (n=28) and patient (n=37) technological skills, and limited infrastructure (n=37)/internet access (n=33). Conclusions Older patients, caregivers, and HCPs show interest in pursuing future telehealth visits but elucidate similar barriers. Facilitating access to technology, as well as to administrative and technology support guides, could promote high quality and equal access to virtual care for the older adult.

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Not Yet Ready for Prime Time: Video Visits in a Home‐Based Primary Care Program

Cited by 18 publications

References 8 publications

Implementing a Virtual Emergency Department: Qualitative Study Using the Normalization Process Theory

Implementing a Virtual Emergency Department: Qualitative Study Using the Normalization Process Theory

“There Is Something Very Personal About Seeing Someone’s Face”: Provider Perceptions of Video Visits in Home-Based Primary Care During COVID-19

Personalized Telehealth: Redesigning Complex Care Delivery for the 65+ During the COVID Pandemic: a Survey of Patients, Caregivers, and Health-care Providers

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