Telemedicine Impact on the Patient–Provider Relationship in Primary Care During the COVID-19 Pandemic

Abstract

Background: The COVID-19 pandemic has necessitated a rapid uptake of telemedicine in primary care requiring both patients and providers to learn how to navigate care remotely. This change can impact the patient–provider relationship that often defines care, especially in primary care. Objective: This study aims to provide insight into the experiences of patients and providers with telemedicine during the pandemic, and the impact it had on their relationship. Research Design: A qualitative study using thematic analysis of semistructured interviews. Subjects: Primary care providers (n=21) and adult patients (n=65) with chronic disease across primary care practices in 3 National Patient-centered Clinical Research Network sites in New York City, North Carolina, and Florida. Measures: Experiences with telemedicine during the COVID-19 pandemic in primary care. Codes related to the patient–provider relationship were analyzed for this study. Results: A recurrent theme was the challenge telemedicine posed on rapport building and alliance. Patients felt that telemedicine affected provider’s attentiveness in varying ways, whereas providers appreciated that telemedicine provided unique insight into patients’ lives and living situations. Finally, both patients and providers described communication challenges. Conclusions: Telemedicine has altered structure and process aspects of primary health care such as the physical spaces of encounters, creating a new setting to which both patients and providers must adjust. It is important to recognize the opportunities and limits that this new technology has to help providers maintain the type of one-on-one attention that patients expect and that contributes to relationship building.

Shared Decision‐Making During Virtual Care Regarding Rheumatologic and Chronic Conditions: Qualitative Study of Benefits, Pitfalls, and Optimization

“…Trusting patient‐provider relationships are best established in person, and the time needed to develop trust is unique for each patient and provider. This phenomenon recurs in medicine, as patients reported difficulty establishing rapport with their primary care providers during VC 19 . Although the specific reason remains unknown, diminished nonverbal communication and the virtual physical examination likely contribute.…”

“…This phenomenon recurs in medicine, as patients reported difficulty establishing rapport with their primary care providers during VC. 19 Although the specific reason remains unknown, diminished nonverbal communication and the virtual physical examination likely contribute. Nonverbal cues carry messages 20 and building relationships can be difficult without them.…”

Physicians, know thy patient

“…Yet, the rapid integration of medical technologies and artificial intelligence in clinical practice have led to increased automation of clinical processes, virtual/ off-site clinical interactions and significantly altered quality of patient-physician communications. 1,2 Moreover, with increasing medical subspecialisation, competing health systems and an ageing population with rising burden of medical comorbidities, much of our present medical care has become fragmented with adverse clinical effects on the patients. In this article, I sought to review what it truly means for a clinician to know a patient, which is actually a highly intricate skill that is needed to meet the standards of person-centred care and requires dedicated commitment to being intentional in information gathering and optimising physician-patient interactions.…”

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

“…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. 10 , 14 , 17 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.…”