Telehealth Challenges During COVID-19 As Reported by Primary Healthcare Physicians in Quebec and Massachusetts

Abstract

Background: The COVID-19 pandemic has driven primary healthcare (PHC) providers to use telehealth as an alternative to traditional face-to-face consultations. Providing telehealth that meets the needs of patients in a pandemic has presented many challenges for PHC providers. The aim of this study was to describe the positive and negative implications of using telehealth in one Canadian (Quebec) and one American (Massachusetts) PHC setting during the COVID-19 pandemic as reported by physicians.Methods: We conducted 42 individual semi-structured video interviews with physicians in Quebec (N = 20) and Massachusetts (N = 22) in 2020. Topics covered included their practice history, changes brought by the COVID-19 pandemic, and the advantages and challenges of telehealth. An inductive and deductive thematic analysis was carried out to identify implications of delivering care via telehealth.Results: Four key themes were identified, each with positive and negative implications: 1) access for patients; 2) efficiency of care delivery; 3) professional impacts; and 4) relational dimensions of care. For patients’ access, positive implications referred to increased availability of services; negative implications involved barriers due to difficulties with access to and use of technologies. Positive implications for efficiency were related to improved follow-up care; negative implications involved difficulties in diagnosing in the absence of direct physical examination and non-verbal cues. For professional impacts, positive implications were related to flexibility (teleworking, more availability for patients) and reimbursement, while negative implications were related to technological limitations experienced by both patients and practitioners. For relational dimensions, positive implications included improved communication, as patients were more at ease at home, and the possibility of gathering information from what could be seen of the patient’s environment; negative implications were related to concerns around maintaining the therapeutic relationship and changes in patients’ engagement and expectations.Conclusion: Ensuring that health services provision meets patients’ needs at all times calls for flexibility in care delivery modalities, role shifting to adapt to virtual care, sustained relationships with patients, and interprofessional collaboration. To succeed, these efforts require guidelines and training, as well as careful attention to technological barriers and interpersonal relationship needs.

Nurses’ experience of using video consultation in a digital care setting and its impact on their workflow and communication

“…Flexibility, efficiency, and access to information have been some of the benefits mentioned by the participants in this study. This is also in line with previous studies in which care professionals such as physicians are satisfied and positive towards using video consultations [44][45][46].…”

“…Some of these challenges include lack of social interaction with co-workers, being dependent on technology, fast changes of the platform, facing patients’ unrealistic expectations about digital healthcare services, dealing with patients’ unfamiliarity with the culture of digital care, and lack of physical contact with patients. These challenges have also been mentioned in some previous studies [10,44,45,46]. Furthermore, the nurses in this study as participants in some other studies felt that technical problems may affect their workflow [32,45].…”

“…Furthermore, the nurses in this study as participants in some other studies felt that technical problems may affect their workflow [32,45]. Improvement of technical solutions has been seen as a necessity in a study focusing on the challenges of video consultations [13].…”

Nurses’ experience of using video consultation in a digital care setting and its impact on their workflow and communication

“…These challenges have also been mentioned in some previous studies [ 10 , 49 – 51 ]. Furthermore, the nurses in this study as participants in some other studies felt that technical problems may affect their workflow [ 37 , 50 ]. Improvement of technical solutions has been seen as a necessity in a study focusing on the challenges of video consultations [ 13 ].…”

Knowledge, Perception, and Barriers to Telehealth Practice among Physical Therapy Practitioners of Riyadh, Saudi Arabia during COVID-19 Pandemic

“…However, the appropriate definition for digital-physical therapy which can be used among literature writers, stakeholders, and policymakers still does not exist. [11] In today's era of advanced technology, physical therapists are well versed with computers and their applications; nevertheless, there is a sizeable number of physical therapists who have never used telehealth or any other digital method to treat their clients. After the first national project in the KSA for telemedicine was introduced in 2011 under STN, a collaborative project between the Saudi Arabian MOH, Ontario Telemedicine Network, and Canada Health Infoway was instituted in 2013 to devise guidelines for the implementation of telemedicine programs in the KSA.…”