Telemedicine Implementation: Perceived Benefits and Challenges During the COVID-19 Pandemic, Personnel (n = 15) from Two Federally Qualified Health Centers in Northern California, 2020–2021
| Theme | Key Finding | Illustrative Quotes |
|---|---|---|
| Patient, provider, and organization benefits | Improved access to care and convenience | “Most of the time my diabetes patients will have every three month visits, but telehealth is really good for those patients who actually need more frequent visits as we are adjusting their medication and changing their insulin … and making sure the problems of med adherence are addressed before we get to that three-month mark so that we can actually see improvement sooner rather than waiting until the next in person visits.” (Physician, Clinic A) |
| Increased opportunity for social support | “When we do the coaching, some of the children are at home and they hear [recommendations about] controlling your portion, cut down the high carbohydrate food like yams. … So, they help, once we’re done with our appointment they started to notice that you have to stop eating this because the health coach said cut this down. … Having telemedicine really helps in that way.” (CHW, Clinic A) | |
| Insights from home environment | “It’s hard to measure this, but there’s just something really pleasing about seeing someone in their own environment. So often patients come to our clinic and, you know, they’re on our turf, and it’s a weird place. You know, you get poked, there’s medicines … It’s just, it’s a clinic. … when we call and talk to them on the phone in their home, you’re seeing their kitchen, their living room, the dining room, you see their kids at school or playing in the background. They, you know, they’re more comfortable where they’re at.” (Leader, Clinic A) | |
| “The virtual ones with video I’ve gotten the chance to have some insight into the family of my patients and their living situation, which can really give you a much fuller picture of their health and wellness environments.” (Physician, Clinic A) | ||
| Increased understanding of medication use | “I think improved medication understanding, understanding of medication. So being able to say, this, the medication bottle you are holding up right now, is for this condition, and then they can tell you how many times a day they use it. Because sometimes even in person, they might not bring in their medication and they might just refer to them as the little white pill versus like when they’re at home their medications are there, and they can actually show you what they have.” (Physician, Clinic A) | |
| Reduced no-show rates | “Our clinic no-show rate kind of varies between like 12 and 16% of the time, some days it’s much higher, some days it’s lower, but they started calling patients when they aren’t there on time and asked them if they would like to do a video visit instead. And quite often they’ll say, yes, they didn’t have a ride, or their car broke down or their husband didn’t get off work in time. And so, they still wanted to receive care they just couldn’t get here. And so, that’s been a huge benefit.” (Leader, Clinic A) | |
| Challenges of virtual care | Reduced information exchange | “In person they tend to tell me the story of their life and on the video visit or telephone, yeah, they go right to the point.” (CHW, Clinic A) |
| “If there is an issue with intimate partner violence or even adult elderly abuse, any of those issues you don’t know who the patient is around. And so, when you’re asking these questions you don’t know if the patient is actually giving you the right answer, is there anything else that’s circumstantial that they’re not able to reveal all the information, and so I think there is less understanding of the patient’s circumstances and the environment on the phone.” (Leader, Clinic B) | ||
| Differing comfort levels | “At the very beginning some people were having fun. … But some other people, they were so shy. They were looking somewhere else except the camera.” (CHW, Clinic A) | |
| “I think older people a lot of the times what I’ve seen is they want to talk to the provider [in person], see the provider, they seem more connected. Some of them know the staff also well and they kind of connect with the staff as well because they’ve been with the clinic for many years and that makes them less anxious. And they have other issues that they can discuss with the provider, personal issues sometimes that we cannot discuss easily over telehealth or Zoom video visits.” (Physician, Clinic B) | ||
| Reduced ability to foster interpersonal connection | “I know a lot of [patients] express the impersonal experience [with telehealth], so they like to be in-clinic to have someone there that they can talk to and kind of have more of a personal experience.” (Care Coordinator, Clinic B) | |
| “I think, you know, there’s always the concern about missing out on your, the interpersonal connection. So, there may be a bit of a difference between patients who are already established and knew their providers and their health coach well versus ones who are maybe newer patients that didn’t have as strong of a connection, but my feeling is that they’re still very much, you know, willing to engage with their care through telehealth.” (Leader, Clinic A) |
Abbreviation: CHW, Community health worker.