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Research ArticleORIGINAL RESEARCH

A Qualitative Study of Primary Care Physicians’ Experiences With Telemedicine During COVID-19

Teresita Gomez, Yohualli B. Anaya, Kevin J. Shih and Derjung M. Tarn
The Journal of the American Board of Family Medicine February 2021, 34 (Supplement) S61-S70; DOI: https://doi.org/10.3122/jabfm.2021.S1.200517
Teresita Gomez
From the Department of Family Medicine, David Geffen School of Medicine at UCLA, University of California, Los Angeles, Los Angeles, CA.
MD
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Yohualli B. Anaya
From the Department of Family Medicine, David Geffen School of Medicine at UCLA, University of California, Los Angeles, Los Angeles, CA.
MD, MPH
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Kevin J. Shih
From the Department of Family Medicine, David Geffen School of Medicine at UCLA, University of California, Los Angeles, Los Angeles, CA.
PhD
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Derjung M. Tarn
From the Department of Family Medicine, David Geffen School of Medicine at UCLA, University of California, Los Angeles, Los Angeles, CA.
MD, PhD
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  • Article
  • Figures & Data
  • References
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Article Figures & Data

Tables

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    Table 1.

    Participant Characteristics

    CharacteristicsN (%)
    Sex
     Female8 (53)
     Male7 (47)
    Age, years
     <35 5 (33)
     35–49 4 (27)
     >50 6 (40)
    Race/ethnicity
     Asian6 (40)
     Hispanic or Spanish origin3 (20)
     More than 1 race/ethnicity1 (7)
     White5 (33)
    Physician type
     Practicing primary care physician11 (73)
     Resident4 (27)
    Use of telemedicine before onset of COVID-19 pandemic
     Yes5 (33)
     No10 (67)
    • COVID-19, coronavirus 2019.

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    Table 2.

    Major Challenges, Benefits, and Suggested Strategies for Telemedicine Visits

    VariablesSuggested Strategies for Telemedicine Visits
    Challenges
     Telemedicine leaves out some groups of patientsPractice level
    Offer technological assistance to all patients before their appointment
    Offer telemedicine visits via whichever technology is available to the patient (smartphone, computer, or tablet)
    Offer easy access to telemedicine visits that does not require downloading an application or accessing a patient portal
    System level
    Partner with internet and smart-device providers to provide patients with technology required to engage in telemedicine
    Provide patients with maps of free Wi-Fi locations
    Partner with phone companies to waive data charges for telemedicine-related services
     Lack of physical examination can be problematicDevelop guidelines for schedulers and physicians to guide decisions about types of visits that are appropriate for telemedicine versus in person
    Establish a “virtual rooming” process immediately before physician visits during which medical assistants gather information normally obtained during in-person visits, including patient home vital signs
    Teach patients to check their vital signs using home equipment (eg, blood pressure monitor, pulse oximeter, thermometer, scale) and bring measurements to telemedicine visit
    Train physicians to hone diagnostic skills when seeing patients via telemedicine
     Physicians lament the lack of personal connections and touch during telemedicine visitsPerform telemedicine visits in private spaces to minimize interruptions
    Establish rapport at the beginning of visits by smiling
    Ensure that patients can see the video feed and hear the physician
    Show patient your face (without face mask)*
    Ensure eye contact by looking directly into the camera (not the monitor)
    As time permits, make small talk as during in-person office visits
    Promote the use of in-person visits for new patients
     Telemedicine visits tend to be shorter than in-person visitsActively solicit additional patient concerns
    Give patient ample time to raise concerns
    Inform patient of expected visit duration
    Consider devoting extra time to patient counseling
     Workflows incorporating telemedicine visits need careful consideration to avoid physician burnoutAllow physicians to individualize decisions about how telemedicine and in-person visits are scheduled to match their desired workflow
    Reserve blocks of time devoted solely to telemedicine or solely to in-person visits
    Support physician ability to set boundaries to prevent scheduling of telemedicine visits outside normal working hours
    If offering primary care telemedicine visits after hours or on weekends, allow physicians to work in shifts
    Benefits
     Enhance patient access to healthcareInform all patients about the availability of telemedicine, particularly those who live far or have limited physical mobility
    Offer mix of video and in-person visits for all patients amenable to telemedicine visits
     Decrease patient no-show rateCall patients within 30 minutes before a scheduled telemedicine appointment to remind them of the appointment and to ensure that they are able to join the visit
     Many conditions can be adequately managed via telemedicineConsider telemedicine for visits focused on counseling, such as review of laboratory results and mental health care
    Consider telemedicine for chronic disease management follow-up visits that do not require physical examinations, such as for diabetes management
    Consider telemedicine for medication reconciliations because patients will have medication bottles available
     Seeing patients’ homes and families enhances patient careLook at patients’ home environments to gain a better sense of their hobbies and living conditions
    Engage and meet family members and pets when they are present
    • ↵* Requires further consideration if face masks and face shields are being used for in-person visits.

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The Journal of the American Board of Family  Medicine: 34 (Supplement)
The Journal of the American Board of Family Medicine
Vol. 34, Issue Supplement
February 2021
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A Qualitative Study of Primary Care Physicians’ Experiences With Telemedicine During COVID-19
Teresita Gomez, Yohualli B. Anaya, Kevin J. Shih, Derjung M. Tarn
The Journal of the American Board of Family Medicine Feb 2021, 34 (Supplement) S61-S70; DOI: 10.3122/jabfm.2021.S1.200517

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A Qualitative Study of Primary Care Physicians’ Experiences With Telemedicine During COVID-19
Teresita Gomez, Yohualli B. Anaya, Kevin J. Shih, Derjung M. Tarn
The Journal of the American Board of Family Medicine Feb 2021, 34 (Supplement) S61-S70; DOI: 10.3122/jabfm.2021.S1.200517
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Keywords

  • Ambulatory Care
  • COVID-19
  • Health Communication
  • Pandemics
  • Primary Care Physicians
  • Primary Health Care
  • Qualitative Research Telemedicine

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