Article Figures & Data
Figures
- Figure 1.
Proportion of clinicians that reported using phone-based visits for at least 20% of total visits compared to all other modalities the COVID-19 pandemic, October 2020 – November 2021.
- Figure 2.
Clinicians motivations for telemedicine use during the COVID-19 pandemic, November 2021.
Tables
- Table 1.
Characteristics of Survey Respondents Who Participated in Five Instances of the Green Center Quick COVID-19 Survey, September 2020–April 2023
Survey fielded 10/2020, n = 591 Survey fielded 11/2020, n = 1460 Survey fielded 03/2021, n = 765 Survey fielded 11/2021, n = 742 Survey fielded 03/2023, n = 847 Clinician Specialty Family medicine 379 (64.1%) 1000 (68.5%) 531 (69.4%) 512 (69.0%) 614 (72.5%) Internal medicine 85 (14.4%) 180 (12.3%) 103 (13.4%) 100 (13.5%) 97 (11.5%) Pediatrics 35 (5.9%) 126 (8.6%) 54 (7.1%) 52 (7.0%) 41 (4.8%) Geriatrics 27 (4.6%) 41 (2.8%) 25 (3.3%) 23 (3.1%) 29 (3.4%) Other* 65 (11%) 113 (7.8%) 52 (6.8%) 55 (7.4%) 66 (7.8%) Clinician Training MD (allopathic) 368 (62.2%) 1021 (69.9%) 555 (72.5%) 519 (69.9%) 620 (73.2%) DO (osteopathic) 26 (4.4%) 79 (5.4%) 32 (4.2%) 36 (4.9%) 56 (6.6%) NP (nurse practitioner) 117 (19.8%) 182 (12.5%) 109 (14.2%) 94 (12.7%) 96 (11.3%) PA (physician assistant) 20 (3.4%) 40 (2.7%) 20 (2.6%) 17 (2.3%) 16 (1.9%) PharmD, PhD or Other 60 (10.2%) 138 (9.5%) 49 (6.4%) 76 (10.2%) 59 (7.0%) Practice Size 10+ clinicians 233 (39.4%) 677 (46.4%) 299 (39.1%) 320 (43.1%) 410 (48.4%) 4 – 9 clinicians 178 (30.1%) 396 (27.1%) 229 (29.9%) 222 (29.9%) 226 (26.7%) 1 – 3 clinicians 180 (30.5%) 387 (26.5%) 237 (31%) 200 (27%) 211 (24.9%) Practice Ownership System-owned 227 (38.4%) 630 (43.2%) 289 (37.8%) 327 (44.1%) 389 (45.9%) Self-owned 157 (26.5%) 365 (25.0%) 248 (32.4%) 183 (24.7%) 199 (23.5%) Group-owned 61 (10.3%) 158 (10.8%) 82 (10.7%) 75 (10.1%) 75 (8.85%) Government 23 (3.9%) 67 (4.6%) 37 (4.8%) 38 (5.1%) 56 (6.61%) None of the Above 124 (20.91%) 240 (16.4%) 109 (14.2%) 119 (16.0%) 128 (15.1%) Practice Setting Primary Care Practice 468 (79.1%) 997 (68.3%) 555 (72.6%) 493 (66.4%) 555 (65.5%) Convenience Care 36 (6.1%) 99 (6.8%) 47 (6.1%) 47 (6.3%) 53 (6.3%) Direct Primary Care or Member-based 0 (0%) 46 (3.2%) 35 (4.6%) 23 (3.1%) 31 (3.7%) Academic 66 (11.2%) 241 (16.5%) 123 (16.1%) 179 (24.1%) 200 (23.6%) Other 21 (3.6%) 77 (5.2%) 5 (0.7%) 0 (0%) 8 (0.9%) Patient Population** FQHC or look-alike 55 (9.3%) 202 (13.8%) 82 (10.7%) 108 (14.6%) 130 (15.3%) Free & charitable clinic 46 (7.8%) 74 (5.1%) 34 (4.4%) 32 (4.3%) 26 (3.1%) Medicaid >50% 86 (14.6%) 254 (17.4%) 129 (16.9%) 123 (16.6%) 165 (19.5%) *Other includes Mental/Behavioral health, and all other specialties (e.g., Emergency Medicine, Palliative Care, Combined Medicine-Pediatrics, etc.).
**For the patient population, respondents could select all that apply. Therefore, results do not total to 100%
Abbreviation: FQHC, federally qualified health center.
- Table 2.
Open-Ended Responses on Telemedicine Adoption from Safety-Net Clinicians, October 2020–November 2021
Key Finding Supporting Quotes Slow Adaptation due to Lack of Resources - Difficulty with quickly converting to telehealth (phone & video) due to lack of support and reimbursement from CMS [Center for Medicare & Medicaid Services] and 3rd party payors up to this pandemic. Need to establish alternative ways to provide care to patients using telehealth, make it a standard of practice and provide Community support such as broadband and public education. (March 2021) - It feels like there is not as much sharing between practices as there could be and a lot of reinventing the wheel. (November 2021) Rapid Implementation Improves Care - Rapidly implementing virtual visits enabled us to introduce a new care delivery model to a reluctant population. With no other choice to receive care in some cases, it was discovered to be convenient. Virtual visits increase access and patient satisfaction. (March 2021) - Our clinic implemented telehealth within about 2 weeks, and we were able to maintain continuity with patients. (March 2021) - Being able to switch to primarily telehealth very quickly, within the span of a week. I hope we will continue telehealth where it makes sense for patients. (March 2021) - Table 3.
Regression Results of Phone-Based Visits Use for at Least 20% of Total Visits Compared to All Other Modalities Among Primary Care Clinicians, October 2020–November 2021
Model 1⤉ Model 2⤈ Model 3↠ (10/2020, n=545) (11/2020, n=1438) (11/2021, n=669) OR (95% CI) OR (95% CI) OR (95% CI) Non-Safety Net Ref Safety-Net Clinicians 2.40 (1.45-3.98)* 2.45 (1.81-3.30)* 1.69 (1.01 - 2.84)* ⤉Adjusted for practice ownership, practice size, practice state
⤈Adjusted for practice ownership, practice size, practice state, practice setting, clinician specialty, clinician certification
↠Adjusted for practice ownership, practice state, clinician specialty, clinician certification
↵*Indicates p-value <.05
Abbreviations: OR, odds ratio; CI, confidence interval.
- Table 4.
Open-Ended Responses on Clinician Motivations from Safety-Net Clinicians, October 2020–November 2021
Key Finding Supporting Quotes Limited Physical Exams I avoid telehealth due to difficulties with connection, and, more importantly, inability to have a physical exam, check blood pressure, check vital signs. It's like I'm expected to treat patients blindfolded with my hands tied behind my back! (November 2021) Being able to offer Telehealth for primary care has been wonderful and I hope it will never go away! We must fund this. However, we are learning its limitations also. Otherwise I have also seen how many people miss coming in to see us in person, how much the human connection has mattered to so many of our patients, who miss seeing us and being touched by us, both figuratively and literally. And the moments of joy vaccinating our staff and our patients - wow that has been wonderful! (March 2021) Limitations by Visit Type I'm concerned that telehealth drives unnecessary visits—ie first a telehealth that requires an in person visit, that really could have been dealt with by a single in person visit. (November 2021) I have done multiple VV that are terrible and I ask for an in person visit and find the person is extremely ill, unstable or suffering a mental health crisis. I think there is a place for virtual visits…extremely helpful for super specialists to see people in rural America and support rural providers but lacking for primary care where we do a lot of social work and mental health care. (November 2021) Positive Experiences Telehealth! Listening and talking are often sufficiently therapeutic without the need for face-to-face contact. We've been doing stuff for years that has not served our patients well. How can we go back? (March 2021) As one tool in our tool bag, telehealth should be here to stay. Never go back to the bad old way. (November 2020) - Table 5.
Open-Ended Responses on Patient Access to Care from Safety-Net Clinicians, October 2020–November 2021
Key Finding Supporting Quotes Increased Patient Volumes - We need more time with patients, they are coming with a huge backlog of problems, no visit is simple. Getting through the phones is a nightmare. I am concerned about malpractice suits due to low access. (November 2021) - Moving to video from phone has been slow in our practice of many low income non English speaking patients. Inbox volume has surged, (as more pts are using portals). And PCP's are increasingly d[r]owning in keeping up, and often providing visit level care through the inbox. (November 2021) Decreased Barriers to Care - The pandemic has given our organization the opportunity to be a champion in providing quality care through innovative approaches such as video and finding creative ways accommodating our at risk population so they continue with [their] care. (March 2021) - Telehealth has opened care to those that don’t have transportation to come to my practice. (March 2021) - The addition of telephone-visits is efficient, documents time spent communicating outside of office visits, and somehow strengthens the bond between patient and provider. (March 2021) Differences in Access due to Patient Factors - Amazing success of our senior citizens to do virtual video visits. Revolutionized care for mentally ill by offering virtual/telehealth care from the privacy of their homes/cars. (March 2021) - Significant differences in access to wifi (none in many homeless shelters) and either a data plan or sufficient minutes for equity is application of telemedicine strategies. (March 2021) - Access to technology should be considered a social determinant factor! (March 2021) - Technology gaps amongst our patient population affects access to primary care and vaccinations. We are a rural practice and many patients don't have internet. Some don't have cell phones. (March 2021)
