BRIEF REPORT
Jennifer L. Frehn, PhD, MPH; Brooke E. Starn, MPH; Hector P. Rodriguez, PhD, MPH; Denise D. Payán, PhD, MPP
Corresponding Author: Jennifer L. Frehn, PhD, MPH; Department of Health Policy and Management - Fielding School of Public Health - University of California; Department of Public Health - School of Social Sciences, Humanities and Arts - University of California
Email: jfrehn@berkeley.edu
DOI: 10.3122/jabfm.2022.220370R2
Keywords: Community Health Centers, COVID-19, Health Services Accessibility, Implementation Science, Pandemics, Primary Health Care, Qualitative Research, Quality Improvement, Safety-net Clinics, Telemedicine
Dates: Submitted: 10-28-2022; Revised: 12-07-2022; 04-10-2023; Accepted: 04-24-2023
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BACKGROUND: Federally qualified health centers (FQHCs) rapidly adopted and implemented telemedicine during the COVID-19 pandemic. This study analyzes FQHC personnel accounts of care redesign strategies to support telemedicine implementation in 2020 and 2021, and identifies improvement opportunities.
METHODS: We conducted semi-structured, in-depth interviews with clinic personnel (N=15) at two FQHCs in Northern California (December 2020-April 2021) to examine telemedicine adoption and use of audio-video and audio-only/phone telemedicine encounters.
RESULTS: FQHC clinicians and staff reported that telemedicine implementation increased access to care and reduced appointment no-show rates. However, a reported reduced ability to develop and foster interpersonal connections negatively impacted clinician-patient relationships. Care redesign strategies included systems to triage appointment types (in person vs. virtual), work-arounds to screen for and address social and non-medical needs, and new protocols to navigate privacy needs for first time telemedicine users. Additionally, increasing remote monitoring capabilities was deemed an important priority for improving telemedicine use for marginalized populations.
CONCLUSIONS: Telemedicine implementation in FQHCs involved care redesign to optimize virtual interactions and care processes. Guidelines and evidence-based practices are needed to improve telemedicine use in FQHCs, including strategies to support interpersonal connections; approaches to virtually screen for and address social needs; and protocols to further mitigate privacy issues. Future research is needed to identify when telemedicine can optimally supplement in-person care to improve patient outcomes and clinic efficiency, particularly in safety net settings.