Patients’ Perspectives on the Shift to Telemedicine in Primary and Behavioral Health Care during the COVID-19 Pandemic

Abstract

Background Studies specifically focused on patients’ perspectives on telemedicine visits in primary and behavioral health care are fairly limited and have often focused on highly selected populations or used overall satisfaction surveys. Objective To examine patient perspectives on the shift to telemedicine, the remote delivery of health care via the use of electronic information and communications technology, in primary and behavioral health care in Federally Qualified Health Centers (FQHCs) during COVID-19. Design Semi-structured interviews were conducted using video conference with patients and caregivers between October and December 2020. Participants Providers from 6 FQHCs nominated participants. Eighteen patients and caregivers were interviewed: 6 patients with only primary care visits; 5 with only behavioral health visits; 3 with both primary care and behavioral health visits; and 4 caregivers of children with pediatric visits. Approach Using a protocol-driven, rapid qualitative methodology, we analyzed the interview data and assessed the quality of care, benefits and challenges of telemedicine, and use of telemedicine post-pandemic. Key Results Respondents broadly supported the option of home-based synchronous telemedicine visits in primary and behavioral health care. Nearly all respondents appreciated remote visits, largely because such visits provided a safe option during the pandemic. Patients were generally satisfied with telemedicine and believed the quality of visits to be similar to in-person visits, especially when delivered by a provider with whom they had established rapport. Although most respondents planned to return to mostly in-person visits when considered safe to do so, they remained supportive of the continued option for remote visits as remote care addresses some of the typical barriers faced by low-income patients. Conclusions Addressing digital literacy challenges, enhancing remote visit privacy, and improving practice workflows will help ensure equitable access to all patients as we move to a new post-COVID-19 “normal” marked by increased reliance on telemedicine and technology.

Development and Validation of a Measure to Assess Patient Experiences With Video Care Encounters

“…A major benefit of video-enabled telehealth is its potential to promote continuity of care . Validity testing revealed that higher scores on the VVUE were associated with both better health care engagement and increased likelihood of continued video visit use in the 6 months after completing the VVUE.…”

“…23,31 A major benefit of video-enabled telehealth is its potential to promote continuity of care. 10,46 Validity testing revealed that higher scores on the VVUE were associated with both better health care engagement and increased likelihood of continued video visit use in the 6 months after completing the VVUE. These findings are especially notable because VVUE scores demonstrated incremental validity to factors previously found to be associated with video visit utilization, including health status, the presence of chronic conditions, and demographic characteristics, such as race and ethnicity and age.…”

“…For example, positive experiences are associated with better perceived usefulness and convenience, such as saving travel time and expense, or enhanced timeliness of care relative to in-person visits . Perceptions of appropriateness of the modality relative to in-person visits are important for positive experience with video visits, such as the acceptability of the lack of physical contact and/or examination, sufficient privacy for both patient and practitioner, and comfort interacting with the practitioner over video, such as being able to speak up and ask questions, also appear important for positive video visit experiences . More broadly, the degree to which video visits are perceived as user-centered, spanning both patient-centered interactions and the usability of technology, are factors associated with satisfaction with video visits and are associated with willingness to continue use of video visits .…”

“…Burgeoning research on the patient experience with video visits suggests that additional domains of experience may be relevant for video visit quality improvement. For example, positive experiences are associated with better perceived usefulness and convenience, such as saving travel time and expense, 8 , 9 , 10 or enhanced timeliness of care relative to in-person visits. 11 , 12 Perceptions of appropriateness of the modality relative to in-person visits are important for positive experience with video visits, such as the acceptability of the lack of physical contact and/or examination, sufficient privacy for both patient and practitioner, 13 , 14 , 15 and comfort interacting with the practitioner over video, such as being able to speak up and ask questions, 16 also appear important for positive video visit experiences.…”

The role of digital literacy in achieving health equity in the third millennium society: A literature review

“…The insights provided by the analysis of the reviewed articles are numerous. A first fundamental point seems to be the importance that is universally recognized to digital literacy as the key to ensuring an equitable distribution of health services in the society of the third millennium, permeated by digitization and technologization ( 16 , 20 , 27 – 29 , 33 , 35 , 37 , 47 , 50 ). In order for it to succeed, it is essential that the promotion of digital literacy should not be a temporary and circumscribed measure, but on the contrary should take on a structural character and be explored at all levels of the organization of society ( 21 ).…”