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Patient and Clinician Experiences With Telehealth for Patient Follow-up Care



Objectives: The increasing and widespread availability of personal technology offers patients and clinicians the opportunity to utilize real-time virtual communication to enhance access to health services. Understanding the perceived value of different modes of care may help to shape the future use of technology. Study design: Cross-sectional surveys of patients and clinicians participating in telehealth virtual video visits (VVVs) in an academic health system. Methods: We administered surveys to 426 unique established patients and 74 attending physicians in our hospital to measure perceptions of the comparative experience of VVVs and office visits; 254 patients and 61 physicians completed the surveys. Results: When comparing VVVs and office visits, 62.6% of patients and 59.0% of clinicians reported no difference in "the overall quality of the visit." VVVs were vastly preferred to office visits by patients for convenience and travel time. A majority (52.5%) of clinicians reported higher efficiency of a VVV appointment. Conclusions: For established patients, VVVs may provide effective follow-up and enhanced convenience when compared with traditional office visits.
40 JANUARY 2019
elemedicine visits have been used in the United States to
enhance access to healthcare, most notably for people who
live in remote and underserved areas.1,2 The increasing avail-
ability of personal technology (89% have internet access, 77% are
online daily3) oers patients and clinicians the opportunity to utilize
real-time virtual communication to enhance access for patients
when transportation challenges, schedules, or physical disability
make oce visits dicult in any geography.4 Although face-to-face
interactions may be preferred in some circumstances by patients or
clinicians, the convenience of accessing healthcare consultations
from the home or oce may save lost time at home or work, travel
time, and missed and rescheduled appointments.
Understanding the
perceived relative value of dierent modes of healthcare services may
help to shape the use of virtual or remote healthcare technologies.
Eective population health management is a balancing act that
requires consideration of patient needs and preferences for more
exible and timely access to consultation, accountability to payers
by managing high costs, and understanding how to leverage new
technologies.12,13 System learning that demonstrates the value of
dierent types of “visits” for the system and the patient is essential.
We initiated the Massachusetts General Hospital (MGH) TeleHealth
program in 2012, oering a range of telemedicine services in 15 clinical
departments. This paper describes experiences with virtual video
visits (VVVs): 2-way audiovisual synchronous videoconferencing
between the MGH clinician and patient. The research reported
here focuses on the patient and clinician experience of a VVV in
a full year of operation to understand its value and comparative
experience with VVVs and oce visits.
Study Setting and Telemedicine
Clinicians in 5 specialties (psychiatry, neurology, cardiology,
oncology, and primary care) were trained in how to provide a
VVV throughout the rst year and on a rolling basis. Oncology
and primary care VVVs were not implemented until late in the
data collection period. Clinicians oered VVVs as an option to
Patient and Clinician Experiences With
Telehealth for Patient Follow-up Care
Karen Donelan, ScD, EdM; Esteban A. Barreto, MA; Sarah Sossong, MPH; Carie Michael, SM; Juan J. Estrada, MSc, MBA;
Adam B. Cohen, MD; Janet Wozniak, MD; and Lee H. Schwamm, MD
OBJECTIVES: The increasing and widespread availability
of personal technology offers patients and clinicians the
opportunity to utilize real-time virtual communication
to enhance access to health services. Understanding the
perceived value of different modes of care may help to shape
the future use of technology.
STUDY DESIGN: Cross-sectional surveys of patients and
clinicians participating in telehealth virtual video visits
(VVVs) in an academic health system.
METHODS: We administered surveys to 426 unique
established patients and 74 attending physicians in our
hospital to measure perceptions of the comparative
experience of VVVs and office visits; 254 patients and
61physicians completed the surveys.
RESULTS: When comparing VVVs and office visits, 62.6%
of patients and 59.0% of clinicians reported no difference
in“the overall quality of the visit.” VVVs were vastly
preferred to office visits by patients for convenience and
travel time. A majority (52.5%) of clinicians reported higher
efficiency of a VVV appointment.
CONCLUSIONS: For established patients, VVVs may
provide effective follow-up and enhanced convenience when
compared with traditional office visits.
Am J Manag Care. 2019;25(1):40-44
VOL. 25, NO. 1 41
Virtual vs In-Person Office Visits
established patients based on their professional
assessment of the suitability of the mode of
visit for the individual patient’s situation (eg,
patient could communicate eectively in this
mode, physical examination was not critical
at the visit). Clinicians were compensated by
MGH for conducting these VVVs because they
were not covered by payers in Massachusetts.
In advance of the VVV, participating patients
received education, instruction, and phone-
based technology support and testing for
installation of the visit software. Patients were
not charged insurance co-payments for the visit.
Survey Methods
The data reported here come from surveys of patients and clinicians
in the MGH TeleHealth program. This study was reviewed and
approved by the Partners Health Care Oce of Human Research.
The surveys we employed were developed by the MGH Center for
TeleHealth leadership and Mongan Institute Health Policy Center
research team, including experts in survey and health services
research, telemedicine, clinical medicine, and health management.
We included selected patient experience measures developed by
the Consumer Assessment of Healthcare Providers and Systems
(CAHPS)15 andaugmented with items developed for this mode of
visit. Surveys were pretested with patients and rened. Key domains
included technology and communication quality, visit quality and
experience, patient time and costs, and willingness to pay for a VVV.
Of 426 eligible patients, 254 (60%) completed surveys using a
secure web tool. Eligible patients had at least 1 VVV during the
accrual period and at least 1 oce visit in the 6-month period
prior. Initial recruitment was by email request within 1 week of
the VVV. Patients whose email addresses were not functional were
contacted by postal mail or telephone. Persistent nonresponders to
the survey were oered a $10 incentive after 4 weeks of attempts
without reaching the patient. Patients younger than 18 years were
not directly contacted; rather, surveys were sent to their parents.
Of 74 eligible clinicians (physicians, nurse practitioners, psycholo-
gists) who provided at least 1 VVV to program patients during the
study period, 61 (82%) completed surveys online, with recruitment
by email. An gift certicate valued at $50 was oered
to each physician as an honorarium for participation.
The results reported here are descriptive; subgroup comparisons
within patient and clinician populations use χ
or t test comparisons
as indicated, and analyses comparing patient and clinician responses
utilize 2-sample t tests of the dierence in proportions. All analyses
were conducted using SPSS version 23 (IBM Corp; Armonk, New York).
Patient characteristics are shown in the eAppendix Table (eAppendix
available at VVV patients were diverse in age and gender
and were predominantly white and non-Hispanic, consistent with
patient demographics in our system. Patients receiving behavioral
health care are overrepresented due to the rapid uptake of VVV
by those clinicians and patients. No signicant dierences were
measured in characteristics of respondents and nonrespondents.
Clinician respondents were psychologists and psychiatrists
(34%), neurologists (38%), cardiologists (10%), oncologists (2%),
andprimary care clinicians (16%).
Patient Experience of VVVs
Patient experience with a VVV was measured in multiple items.
Responses are shown in the Table by specialty, comparing neurology
and cardiology patient responses with those of the psychiatry patients
(referent). We used 4 measures from the CAHPS Clinician Group visit
to assess patient experience with eciency and communication
during VVVs. Overall, 80% or more respondents answered “yes,
denitely” to these items; 82.3% responded “yes, denitely” to
whether they would recommend VVV to their family and friends.
On a scale of 0 to 10, where 0 is the worst possible visit and 10 is
the best visit, 68.5% rated the visit a 9 or 10.
We asked patients to consider whether the care provided during
their recent VVV could have been provided in another way and
still met their needs, asking “Do you think the health issues you
discussed with clinicians today could just as easily have been
addressed by [insert visit mode]?” Nearly 90% of patients agreed
that theirissues could also have been addressed in an oce visit
(denitely, 70.8%; somewhat, 17.8%) and nearly 60% by telephone
calls (denitely, 23.2%; somewhat, 36.7%). The results for secure
email (denitely, 7.2%; somewhat, 23.5%) and text messaging
(denitely, 3.6%; somewhat, 12.7%) suggest that they are less often
appropriate substitutes (data not shown).
Patient and Clinician Comparisons of Office Visits
and VVVs
The Figure shows patient and clinician responses to a series of
comparative questions about oce visits and VVVs that were asked
of both groups. Expanded data are shown in eAppendix Figures 1
and 2—one with patient data, one with clinician data—and include
Telemedicine visits have been used to provide healthcare access to more remote populations.
In a busy health system, telehealth visits were incorporated for established patients to allow
patient–clinician interaction in a new, more convenient mode. In the first full year of patient
visits in this new mode, we found that:
Patients rated these visits highly and the majority would recommend them to family and friends.
Using standard measures of patient experience, most patients and clinicians perceived no
loss of communication in virtual video visits compared with office visits, although clinicians
were somewhat more likely to see loss of personal connection as a problem.
Patients perceived considerable added convenience, saved travel time, and expressed
willingness to pay co-payments for this visit option.
Virtual visits are an important and useful option in clinical care.
42 JANUARY 2019
several items that were directed only to one
group or the other.
Most patients (62.6%) and clinicians (59.0%)
reported “no dierence” between virtual and
oce visits on “the overall quality of the visit.
When rating “the personal connection felt
during the visit,” 32.7% of patients and 45.9%
of clinicians reported that the “oce visit is
better,” but more than half of the respondents
(patients, 59.1%; clinicians, 50.8%) said that
there was “no dierence.
Patient Willingness to Pay for VVV
eAppendix Figure 3 shows data on patient
willingness to pay for VVV out of pocket. Patients
were not initially charged co-payments. However,
the majority of patients expressed a willingness
to pay a co-payment of up to $50. Among those
willing to bear the full cost of the VVV, more than
one-third had no current co-payment and all
had private (vs public) insurance. We conducted
bivariate analyses of the willingness to make
co-payments for VVV by both self-reported
travel time and cost of attending oce visits.
Among those who traveled more than 90 minutes
to an oce visit, 51.5% indicated they would
pay a co-payment of more than $50 for a VVV
compared with 30.4% of those who traveled less
than 30 minutes. Among patients who spent
$25 or more on travel to attend an oce visit,
73.2% would pay a co-payment of $26 to $50
for a VVV and 97.6% would pay a co-payment
of $10 to $25 (travel data not shown).
Increased interest in new strategies for managing
population health and episodic specialty care,
coupled with the widespread availability of
communications technologies, have encour-
aged the exploration of the appropriate roles
of dierent modes of clinical encounters or
Our data—gathered from patients and
clinicians during and following an initial full
year of experience with the MGH Center for
TeleHealth’s VVV implementation—show a high
degree of patient and clinician satisfaction, as
measured by both ratings of overall visit quality
and willingness to recommend the visits.
VVVs are perceived by the majority of patients
as the same as or better than oce visits in
convenience and cost, at the same level of
TABLE. Patient Experience With Virtual Video Visits
(N = 254)
(n = 113)
(n = 92)
(n = 30)
Thinking about your most recent virtual
video visit, please tell us how much you
agree with the following items:
I saw my clinician within 15 minutes of
my appointment time. Reference P = .609 P = .284
Yes, definitely agree 88.2% 90.3% 88.0% 83.3%
Yes, somewhat agree 6.3% 6.2% 4.3% 10.0%
No 3.5% 1.8% 4.3% 6.7%
Not answered 2.0% 1.8% 3.3% 0.0%
My clinician explained things in a way
that was easy to understand. Reference P = .046 P = .791
Yes, definitely agree 92.9% 95.6% 88.0% 96.7%
Yes, somewhat agree 3.9% 1.8% 7.6% 3.3%
No 0.8% 0.0% 1.1% 0.0%
Not answered 2.0% 2.7% 3.3% 0.0%
My clinician listened carefully to me. Reference P = .026 P = .791
Yes, definitely agree 92.5% 95.6% 87.0% 96.7%
Yes, somewhat agree 4.7% 1.8% 9.8% 3.3%
No 0.8% 0.0% 1.1% 0.0%
Not answered 2.0% 2.7% 2.2% 0.0%
My clinician spent enough time with me. Reference P = .002 P = .656
Yes, definitely agree 98.8% 94.7% 80.4% 96.7%
Yes, somewhat agree 7.1% 2.7% 15.2% 3.3%
No 1.2% 0.9% 1.1% 0.0%
Not answered 2.0% 1.8% 3.3% 0.0%
On a scale from 0 to 10, where 10 is your
BEST visit and 0 is your WORST possible visit,
how would you rate your virtual video visit?
Reference P = .771 P = .168
9-10 68.5% 66.3% 67.4% 80.0%
7-8 25.2% 27.5% 23.9% 20.0%
6 5.1% 5.3% 6.5% 0.0%
Would you recommend this clinician
toyour family and friends? Reference P = .034 P = .544
Yes, definitely agree 89.0% 93.8% 84.8% 96.7%
Yes, somewhat agree 7.5% 5.3% 8.7% 3.3%
No 1.6% 0.0% 2.2% 0.0%
Not answered 2.0% 0.9% 4.3% 0.0%
Would you recommend a virtual visit to
your family and friends? Reference P = .416 P = .076
Yes, definitely agree 82.3% 86.7% 82.6% 66.7%
Yes, somewhat agree 13.4% 11.5% 10.9% 33.3%
No 0.8% 0.0% 2.2% 0.0%
Not answered 3.5% 1.8% 4.3% 0.0%
Source: Data from the TeleHealth Patient Survey, February 2014-March 2015.
VOL. 25, NO. 1 43
Virtual vs In-Person Office Visits
quality and personal connection. Patients appear to value the
face-to-face interactive nature of VVVs; they perceive oce or
telephone encounters as the main alternatives to this new type
of visit, rather than email or structured questionnaires, likely
because they maintain a real-time personal connection. Even
though VVVs represent a great convenience, our data reinforce that
they are unlikely to be a useful substitute for an in-oce visit in
some clinical situations—for example, those with more complexity
and need for physical examination or observation. More research
is needed to study the association of the care delivery modality
(in-person vs telehealth) with total cost and clinical outcomes and to
understand settings in which telehealth aects healthcare value.
Theregulatory, administrative, and legal environment related to
the conduct of telehealth visits is in constant ux; delivery of care
to established patients across state lines adds further complexity.
The Chronic Care Act of 2017, enacted in 2018, takes some small
steps toward relaxing reimbursement and regulatory restrictions
in selected diseases and insurance markets; hopefully, this trend
will continue.
Patient participants were selected for these visits by their clinicians
based on their suitability, as determined during prior oce visits
as established patients. This was not a controlled study. These data
were gathered in the rst full year of VVV implementation in our
system and are primarily from VVVs for a specialty, so they very likely
do not fully reect the challenges or opportunities of using VVVs
in primary care settings. Surveys are subject to sources of error and
bias; we attempted to minimize these with high-quality methods
and response rate enhancement methods. Lastly, Massachusetts
is not among the 31states that now routinely require third-party
reimbursement for telehealth visits; our health system chose to
support reimbursement to clinicians. It is unknown if the level of
reimbursement created positive or negative incentives. Further study
is needed, including improved models to compensate clinicians, to
measure and dene the appropriate mix of virtual and oce visits,
and to understand the role of other modes of care.
With the inexorable adoption of digital oerings to meet many of the
needs of today’s consumers, it is likely that telehealth will increasingly
be adopted over the next several years. Our data suggest that initial
experiences for patients and clinicians were positive and that, for
most encounters, these VVVs are just as clinically eective and less
expensive for both patient and provider compared with in-person
visits. The fears of distracted, overwhelmed providers and a loss of
human connection between patient and provider have been raised
repeatedly with the rising use of computers in the doctor’s oce.
Interestingly, this issue was not a central concern to participants in
our VVV program, perhaps due to the use of VVVs with established
patients. These visits are not just replacements for in-oce visits; they
hold the possibility of new avenues for care delivery, more frequent
but shorter encounters, and opportunity for earlier intervention.
Further studies are needed to test dierent provider compensation
models to measure and dene the appropriate mix of virtual, oce,
and other modes of care and to establish appropriateness criteria for
the use of telehealth encounters. These issues are all important in
the further use of this technology as part of eective and ecient
patient-centered care and population management.
FIGURE. Patient and Clinician Comparisons of Virtual and Office Visits
Full page
0% 20% 40% 60% 80%
Length of visit required to assess and treat patient (provider)
Amount of time I spend with my clinician (patient)
Comfort I feel sharing personal or private information (patient)
Confidence health concern can be taken care of (patient)
The ability to see a physical problem (provider)
Ability to show clinician a physical problem (patient)
Personal connection I feel with the patient (provider)
Personal connection I feel with clinician during the visit (patient)
Overall quality of the visit (provider)
Overall quality of the visit (patient)
Virtual visit is better No difference Office visit is better Does not apply to me/not answered
44 JANUARY 2019
should further the aims of improving the quality of healthcare
and addressing the Institute of Medicine domains of quality, with
special attention to overcoming existing barriers in access to care,
including the burden of time and nancial costs that patients and
families bear in attending traditional oce visits. n
Author Aliations: Mongan Institute Health Policy Center (KD, EAB, CM),
MGH Center for TeleHealth (JJE, LHS), Department of Neurology (JJE, LHS), and
Department of Psychiatry (JW), Massachusetts General Hospital, Boston, MA; Flare
Capital Partners (SS), Boston, MA; Applied Physics Laboratory, Johns Hopkins
University (ABC), Laurel, MD; Department of Neurology, Johns Hopkins Hospital
and Health System (ABC), Baltimore, MD.
Source of Funding: Massachusetts General Hospital Institutional Funds.
Author Disclosures: Dr Cohen is employed with and provided expert testimony
for Johns Hopkins University Applied Physics Laboratory, which develops health
technology, including telemedicine-related technology. Dr Wozniak’s spouse
has received royalties from UpToDate; consultation fees from Advance Medical,
FlexPharma, Merck, Otsuka, and Gerson Lehman Group; and research support
from RLS Foundation. Dr Schwamm has received a Patient-Centered Outcomes
Research Institute grant on tele–palliative care and is the director of the MGH
Center for TeleHealth. The remaining authors report no relationship or nancial
interest with any entity that would pose a conict of interest with the subject
matter of this article.
Authorship Information: Concept and design (KD, SS, CM, JJE, ABC, JW, LHS);
acquisition of data (KD, EAB, SS, CM, JJE, ABC, JW, LHS); analysis and interpretation
of data (KD, EAB, SS, CM, JJE, ABC, JW, LHS); drafting of the manuscript (KD, EAB,
CM, LHS); critical revision of the manuscript for important intellectual content
(KD, SS, CM, JJE, ABC, JW, LHS); statistical analysis (KD, EAB, CM, JJE, ABC, JW, LHS);
provision of patients or study materials (KD, SS, CM, JJE, ABC, JW, LHS); obtaining
funding (KD, SS, CM, JJE, ABC, JW, LHS); administrative, technical, or logistic support
(KD, SS, CM, JJE, ABC, JW, LHS); and supervision (KD, SS, CM, JJE, ABC, JW, LHS).
Address Correspondence to: Karen Donelan, ScD, EdM, Mongan Institute Health
Policy Center, Massachusetts General Hospital, 100 Cambridge St, Ste 1600, Boston,
MA 02114. Email:
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Visit to download PDF and eAppendix
eAppendix Table. Respondent Characteristics
(N = 254)
135 (53.1%)
119 (46.9%)
Age, years
68 (26.8%)
51 (20.1%)
79 (31.1%)
56 (22.0%)
White, non-Hispanic
220 (86.6%)
34 (13.4%)
Insurance type
Private insurance
195 (76.8%)
12 (4.7%)
41 (16.1%)
Patient payments
6 (2.4%)
Service or department
113 (44.5%)
92 (36.2%)
30 (11.8%)
19 (7.5%)
Device used for virtual video visit
Desktop computer
44 (17.3%)
Laptop computer
146 (57.5%)
56 (22.1%)
2 (0.8%)
3 (1.2%)
Travel time
How long does it take you to travel to MGH for office visits?
40 minutes
63 (24.8%)
41-59 minutes
54 (21.3%)
60-89 minutes
59 (23.2%)
90 minutes
66 (26.0%)
Not answered
12 (4.7%)
eAppendix Figure 1. TeleHealth Patients’ Perceptions of Virtual Video Visits vs Office Visits
Source: Data from MGH TeleHealth Patient Survey.
eAppendix Figure 2. TeleHealth Clinicians’ Perception of Virtual Video Visits vs Office Visits
Source: Data from MGH TeleHealth Clinician Survey.
0% 20% 40 % 60% 80% 100%
Overall quality of the visit
Personal connection I feel with the patient
The ability to see a physical problem
Ease of ordering tests for the patient
Ease of accessing patient records during the visit
Ease of scheduling followup visits
Workflow outside of the visit (before and after)
Length of visit required to assess and treat patient
Efficiency of the visit
Timely patient access to followup appointments
Virtual visit is bette r No difference Office visit is better Does not apply to me
eAppendix Figure 3. TeleHealth Patients’ Willingness to Pay for Virtual Video Visit
Source: Data from MGH TeleHealth Patient Survey.
020 40 60 80 100
Full cost of visit
Copay $26-50
Copay $10-25
Yes, Definitely Yes, Somewhat No Don't know/Not answered
... Informational videos providing instruction in self-monitoring and health education and awareness tailored to specific morbidities have been shown to reduce hospitalizations among people at high risk for re-hospitalization with heart failure, chronic obstructive pulmonary disease (COPD), diabetes mellitus, or hypertension [2]. Additionally, at a large hospital outpatient setting staffed by physicians trained to deliver telemedicine, both patients and clinicians found no difference in the quality of virtual vs. in-person office visits [3]. ...
... Imagining as usual 80 (50.3) of patient comfort was 8 (3). Physicians reported that 46.3% of their patients reported no difficulties with telemedicine methods, but the rest reported at least one problem. ...
... Overall, studies reported high satisfaction and high quality of telemedicine. Telephone and video counseling were rated highly by primary care physicians and patients [3,4], with video counseling receiving superior ratings [21]. The physicians in our study indicated that delivering care using both telephone and video was reasonable to highly convenient and rated the overall quality of telephone and online platforms relatively high despite pointing it inferior to face-to-face counseling. ...
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Background Social distancing and lockdowns were implemented during the first period of the COVID-19 pandemic. Primary care physicians needed to adapt quickly to deliver remote care/telemedicine. Methods A cross-sectional, 47-item online Google Survey was distributed through the Israel Association of Family Physicians (IAFP) mailing list between March 31-May 5, 2020. The questionnaire included demographics, physician characteristics, and information on usage and perceived telemedicine quality. Sampling weights by sex and age groups were applied. Results One hundred fifty-nine primary care physicians (10.6% of registered IAFP members; 63.5% women; mean age 53.4 ± 10.4 years and median professional experience 21.3 years) replied to the survey. The majority (59.7%) of the participants performed a mixture of in-person along with phone counseling. About 40% had no former telemedicine experience. The majority indicated that telephone and video formats were inferior to in-person consultation (68%, 57.1% online and phone, respectively). The overall counseling quality grade (on a 1–10 scale,)median (IQR)) was 6.2 (3) for telephone and 7(2) for video. While 66.9% reported experiencing no challenges, 10% had technical problems, 10% interpersonal problems, 5.6% scheduling difficulties, and 7.5% other difficulties. Majority of 56.6% physicians indicated they prescribed more antibiotics,16.4% sent more blood tests, 24.5% referred more to experts, and 49.7% referred more to imaging in comparison to usual counseling. Higher phone quality score was significantly associated with physicians who indicated not prescribing more antibiotics during the pandemic (OR = 0.30, 95%CI 0.134–0.688, p = 0.004). Higher online quality score was associated with physicians who indicated not sending more blood tests during the pandemic (OR = 0.06 95%CI 0.008–0.378, P = 0.003). Conclusions Our findings suggest telehealth holds considerable promise for counseling in the primary care setting. However, interpersonal challenges raised by physicians should be understood in-depth to develop tailored training and further examine it in randomized trials while integrating patient-reported outcomes. Finally, further research on utility, cost, and cost-efficiency during remote counseling with follow-ups, medical prescribing, and additional referrals is needed.
... For example, there are concerns that telehealth technologies may impact health equity if uptake, particularly for synchronous audio-video technologies, is greater among wealthier, white, and younger patients [72,73]. Variation of telehealth use is due to multi-factorial drivers including differences in social determinants (e.g., access to a reliable internet connection, patient and provider preferences, technological literacy, condition complexity, and medical visit type) [74][75][76]. However, evidence from the VA, which serves a significant rural patient population, suggests that telephonic telehealth may be an effective mechanism for improving access to care for more remote, underserved communities [77,78]. ...
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Purpose of Review There is a growing evidence base describing population health approaches to improve blood pressure control. We reviewed emerging trends in hypertension population health management and present implementation considerations from an intervention called Team-supported, Electronic health record-leveraged, Active Management (TEAM). By doing so, we highlight the role of population health managers, practitioners who use population level data and to proactively engage at-risk patients, in improving blood pressure control. Recent Findings Within a population health paradigm, we discuss telehealth-delivered approaches to equitably improve hypertension care delivery. Additionally, we explore implementation considerations and complementary features of team-based, telehealth-delivered, population health management. By leveraging the unique role and expertise of a population health manager as core member of team-based telehealth, health systems can implement a cost-effective and scalable intervention that addresses multi-level barriers to hypertension care delivery. Summary We describe the literature of telehealth-based population health management for patients with hypertension. Using the TEAM intervention as a case study, we then present implementation considerations and intervention adaptations to integrate a population health manager within the health care team and effectively manage hypertension for a defined patient population. We emphasize practical considerations to inform implementation, scaling, and sustainability. We highlight future research directions to advance the field and support translational efforts in diverse clinical and community contexts.
... On the other, patients who use telemedicine are overwhelmingly positive about the experience, reporting high quality and satisfaction levels (Jacobs et al., 2019;Kruse et al., 2017;Polinski et al., 2016). For many patients, electronic consultations were preferred for convenience and travel time (Donelan et al., 2019). ...
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Telemedicine can expand access to health care at relatively low cost. Historically, however, demand for telemedicine has remained low. Using administrative records and a difference‐in‐differences methodology, we estimate the change in demand for telemedicine experienced after the onset of the COVID‐19 epidemic and the imposition of mobility restrictions. We find that the number of telemedicine calls made during the pandemic increased by 230 percent compared to the pre‐pandemic period. The effects were mostly driven by older individuals with preexisting conditions who used the service for internal medicine consultations. The demand for telemedicine remained relatively high even after mobility restrictions were relaxed, which is consistent with telemedicine being an “experience good.” These results are a proof of concept for policy makers to use such relatively low‐cost medical consultations, made possible by new technologies, to provide needed expansion of access to health care.
The use of teleconsultation / telemedicine has recently undergone rapid growth and proliferation. Although the feasibility of many applications has been tested for nearly 30 years, data concerning the costs, effects, and effectiveness of telemedicine are limited. Teleconsultation / Telemedicine is a convenient tool for providing medical care remotely. It is routinely offered as an alternative to face-to-face consultations in healthcare settings all over the world. Due to the COVID-19 pandemic and increased use of telemedicine in everyday clinical practice, the effectiveness of this modality and patient satisfaction with telemedicine is a subject of growing concern. Researchgate, PubMed and Google Scholar databases were searched. Papers published between January 2020 and April 2022 which met inclusion and exclusion criteria were analyzed. During the COVID-19 pandemic patients have found telemedicine a beneficial tool for consulting healthcare providers. A high level of satisfaction with telehealth was observed in each study across every medical specialty. Telemedicine is undoubtedly a convenient tool that has helped ensure continuity of medical care during the COVID-19 pandemic thanks to its considerable potential. In particular situations, telehealth may adequately replace face-to-face consultation. Regular patients’ feedback is necessary to improve the use of telemedicine in the future.
Background The COVID-19 pandemic and the need for physical distancing has led to rapid uptake of virtual visits to deliver ambulatory health care. Despite widespread adoption, there has been limited evaluation of the quality of care being delivered through virtual modalities for ambulatory care sensitive conditions (ACSCs). Objective To characterize patients’ and providers’ experiences with the quality and sustainability of virtual care for ACSCs. Design This was a multi-method study utilizing quantitative and qualitative data from patient surveys, provider surveys, and provider focus groups at a large academic ambulatory care hospital between May 2020 and June 2021. We included patients and providers utilizing telephone or video visits for the following ACSCs: hypertension, angina, heart failure, atrial fibrillation, diabetes, chronic obstructive pulmonary disease, or asthma. Main measures Quantitative and qualitative patient and provider survey responses were mapped to the Six Domains of Healthcare Quality framework. Provider focus groups were coded to identify themes within each quality domain. Key results Surveys were completed by 110/352 (31%) consenting patients and 20/61 (33%) providers. 5 provider focus groups were held with 14 participants. Patients found virtual visits to be generally more convenient than in-person visits for ACSCs. The perceived effectiveness of virtual visits was dependent on the clinical and social complexity of individual encounters. Respondents reported difficulty forming effective patient-provider relationships in the virtual environment. Patients and providers felt that virtual care has potential to both alleviate and exacerbate structural barriers to equitable access to care. Conclusions In a large academic ambulatory care hospital, patients and providers experienced the quality of virtual visits for the management of ACSCs to be variable depending on the biopsychosocial complexity of the individual encounter. Our findings in each quality domain highlight key considerations for patients, providers and institutions to uphold the quality of virtual care for ACSCs.
Telehealth is an advanced technology using digital information and telecommunication facilities that provide access to health services from a distance. It slows the transmission factor of COVID-19, especially for elderly patients and patients with chronic diseases during the pandemic. Therefore, understanding patient perspectives on telehealth services and the factors impacting their option of telehealth service will shed light on the measures that healthcare providers can take to improve the quality of telehealth services. This study aimed to evaluate perceptions of telehealth services among different patient groups and explore various aspects of telehealth utilization in the United States during the COVID-19 pandemic. An online survey distributed via social media platforms was used to collect research data. In addition to the descriptive statistics, both correlation and regression analyses were conducted to test research hypotheses. The empirical results highlighted that the factors such as accessibility to telehealth services and the type of specialty clinics that the patients required play important roles in the effectiveness of telehealth services they received. However, the results found that patients' waiting time to receive telehealth services and their annual income did not significantly influence their desire to select receiving healthcare services via telehealth. The limitations of the study and future research directions are discussed.
Background In the era of the Coronavirus Disease 2019 (COVID-19) pandemic, health care systems wish to harness the advantage of distant care provision to transcend barriers to access health care facilities. This study aims to investigate general population perceptions (acceptance, comfort, perceived ease of use and perceived quality of care) toward telehealth. Methods A cross-sectional survey was conducted using a validated online questionnaire. The questionnaire investigated the general population’s familiarity and experience with virtual provision of health care (telehealth) in Kuwait. Descriptive statistics and multivariate analysis were performed. Results A total of 484 responses were received. Of those, 65% (N = 315) showed high acceptance of telehealth of which 73.5% (N = 119) were comfortable using it and 48.2% (N = 78) perceived themselves capable of utilizing its systems. Multivariate analysis showed that participants with moderate or high comfort score and those who perceived equal quality of care received from Virtual Visits (VV) are more likely to accept a virtual call from their health care provider compared to those with low comfort score (odds ratio (OR): 4.148, 95% confidence interval (CI): 1.444–11.91, P = 0.008, OR: 20.27, 95% CI: 6.415–64.05, P < 0.0001, OR: 2.585, 95% CI: 1.364–4.896, P < 0.004, respectively). Conclusions Perceptions of telehealth were overall positive, indicating a tendency to accept the implementation of such technology.
There was a paucity of research describing the perspectives and experiences of clinical genetics providers in telehealth prior to the SARS‐CoV‐2 pandemic. The available literature focused primarily on provider satisfaction and offered limited insight into genetics providers’ work in telehealth. The purpose of this study, conducted just prior to the widespread knowledge of SARS‐CoV‐2 in the United States and mass transition to telehealth, was to understand the telehealth process from the vantage of genetics providers working in telehealth practice settings. This research employed grounded theory using the constant comparative method in coding and analysis of data to generate theory. Ten genetics providers were interviewed over the phone about their experiences, specifically the efficacy of telehealth work, providers’ perspectives of patient outcomes, and personal fulfillment derived from telehealth patient care. Six themes emerged in the study: Making Professional Choices, Increasing Patient Access, Providing Effective Services, Understanding Telehealth Limits, Feelings about Telehealth Consultations, and Deepening Personal Fulfillment. These major themes guided the creation of the Theoretical Model of Telehealth Providers in Genetics, which depicts the connections between providers’ personal fulfillment in telehealth, commitment to patient services, and the provision of telehealth to the public. This model may help others who are working on telehealth initiatives or developing telehealth programs. Findings from this study can support the current use and the growth of telehealth in genetics as a result of the SARS‐CoV‐2 pandemic. Future research is needed to describe the telehealth process and develop valid instruments for assessing and measuring the constructs of the Theoretical Model of Telehealth Providers in Genetics.
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The purpose of this study was to explore the quality attributes required for effective telemedicine encounters from the perspective of the patient. We used a multi-method (direct observation, focus groups, survey) field study to collect data from patients who had experienced telemedicine encounters. Multi-perspectives (researcher and provider) were used to interpret a rich set of data from both a research and practice perspective. The result of this field study is a taxonomy of quality attributes for telemedicine service encounters that prioritizes the attributes from the patient perspective. We identify opportunities to control the level of quality for each attribute (ie, who is responsible for control of each attribute and when control can be exerted in relation to the encounter process). This analysis reveals that many quality attributes are in the hands of various stakeholders, and all attributes can be addressed proactively to some degree before the encounter begins. Identification of the quality attributes important to a telemedicine encounter from a patient perspective enables one to better design telemedicine encounters. This preliminary work not only identifies such attributes, but also ascertains who is best able to address quality issues prior to an encounter. For practitioners, explicit representation of the quality attributes of technology-based systems and processes and insight on controlling key attributes are essential to implementation, utilization, management, and common understanding.
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Discussions of health care delivery and payment reforms have largely been silent about how behavioral health could be incorporated into reform initiatives. This paper draws attention to four patient populations defined by the severity of their behavioral health conditions and insurance status. It discusses the potentials and limitations of three prominent models promoted by the Affordable Care Act to serve populations with behavioral health conditions: the Patient-Centered Medical Home, the Health Home initiative within Medicaid, and the Accountable Care Organization. To incorporate behavioral health into health reform, policymakers and practitioners may consider embedding in the reform efforts explicit tools-accountability measures and payment designs-to improve access to and quality of care for patients with behavioral health needs.
Conference Paper
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The effectiveness of the telemedicine encounter is dependent on the use of state-of-the-art technology and the quality of the technology-based interactions. We take a socio-technical approach to understanding quality during telemedicine encounters. This approach has not been well studied in telemedicine service encounter research. To enrich understanding, we use a multimethod (direct observation, interview, focus group, survey) field study to collect and interpret a rich set of data. We conduct this study from two perspectives. First, we focus on the perceptions of the medical providers (e.g. physicians) who directly use the technology and are accountable for patient care. We then compare provider perspectives to those of patients, who act as indirect users of telemedicine technology and are the ultimate consumers of health care services provided via telemedicine. The result of this field study is a comparative framework of quality attributes for telemedicine service encounters that prioritizes the attributes from the provider and patient perspectives.
This study describes trends in telemedicine utilization in Medicare from 2004-2013.Telemedicine may increase access and improve quality, particularly in rural areas.1 Because inadequate reimbursement may limit telemedicine use, 29 states have passed telemedicine parity laws mandating that commercial insurers reimburse telemedicine visits.2 In contrast, Medicare limits telemedicine reimbursement to select live video encounters with the patient at a clinic or facility in a rural area.3 Federal legislation has been proposed to expand Medicare telemedicine coverage. To inform the debate regarding telemedicine expansion, we describe trends in telemedicine utilization in Medicare from 2004-2013.
One-quarter of U.S. patients do not have a primary care provider or do not have complete access to one. Work and personal responsibilities also compete with finding convenient, accessible care. Telehealth services facilitate patients' access to care, but whether patients are satisfied with telehealth is unclear. We assessed patients' satisfaction with and preference for telehealth visits in a telehealth program at CVS MinuteClinics. Cross-sectional patient satisfaction survey. Patients were aged ≥18 years, presented at a MinuteClinic offering telehealth in January-September 2014, had symptoms suitable for telehealth consultation, and agreed to a telehealth visit when the on-site practitioner was busy. Patients reported their age, gender, and whether they had health insurance and/or a primary care provider. Patients rated their satisfaction with seeing diagnostic images, hearing and seeing the remote practitioner, the assisting on-site nurse's capability, quality of care, convenience, and overall understanding. Patients ranked telehealth visits compared to traditional ones: better (defined as preferring telehealth), just as good (defined as liking telehealth), or worse. Predictors of preferring or liking telehealth were assessed via multivariate logistic regression. In total, 1734 (54 %) of 3303 patients completed the survey: 70 % were women, and 41 % had no usual place of care. Between 94 and 99 % reported being "very satisfied" with all telehealth attributes. One-third preferred a telehealth visit to a traditional in-person visit. An additional 57 % liked telehealth. Lack of medical insurance increased the odds of preferring telehealth (OR = 0.83, 95 % CI, 0.72-0.97). Predictors of liking telehealth were female gender (OR = 1.68, 1.04-2.72) and being very satisfied with their overall understanding of telehealth (OR = 2.76, 1.84-4.15), quality of care received (OR = 2.34, 1.42-3.87), and telehealth's convenience (OR = 2.87, 1.09-7.94) CONCLUSIONS: Patients reported high satisfaction with their telehealth experience. Convenience and perceived quality of care were important to patients, suggesting that telehealth may facilitate access to care.
To examine patient preuse acceptance and perceptions of video visit (VV) technology within an ambulatory urology setting. Patients treated by a single urology department from January to June 2013 were identified. A Web-based survey was conducted evaluating patient demographics, preuse perceptions, and acceptance of VV. In total, 1378 patients (25%) completed the survey; of which 868 (63%) were willing to participate in VV for their urologic care. Compared with patients "unlikely," those "likely" to participate in VV were younger (62 vs 65 years), had a college education (77% vs 65%), had previous exposure to videoconference technology (57% vs 38%), were more comfortable discussing new symptoms (56% vs 30%) and sensitive information (48% vs 27%), and played an active role in their healthcare (65% vs 54%). Moreover, patients willing to participate in VV traveled larger distances (>90 minutes; 69% vs 58%), missed more work (>1 day; 39% vs 29%), and incurred greater expenses for their care (>$250; 52% vs 25%) relative to those who were unlikely. After controlling for associated patient characteristics, a high level of agreement among urology-specific questions remained independently associated with greater likelihood of VV acceptance among both male and female patients. A large proportion of patients are willing to participate in VV for their urologic care. This may have significant implications by reducing costs and increasing access to, and quality of, health care services. These findings may assist urologists in strategically directing future efforts to reach diverse patient populations via VV technology. Copyright © 2015 Elsevier Inc. All rights reserved.
Telehealth is widely believed to hold great potential to improve access to, and increase the value of, health care. Gaining a better understanding of why some hospitals adopt telehealth technologies while others do not is critically important. We examined factors associated with telehealth adoption among US hospitals. Data from the Information Technology Supplement to the American Hospital Association's 2012 annual survey of acute care hospitals show that 42 percent of US hospitals have telehealth capabilities. Hospitals more likely to have telehealth capabilities are teaching hospitals, those equipped with additional advanced medical technology, those that are members of a larger system, and those that are nonprofit institutions. Rates of hospital telehealth adoption by state vary substantially and are associated with differences in state policy. Policies that promote private payer reimbursement for telehealth are associated with greater likelihood of telehealth adoption, while policies that require out-of-state providers to have a special license to provide telehealth services reduce the likelihood of adoption. Our findings suggest steps that policy makers can take to achieve greater adoption of telehealth by hospitals.
"Telehealth" refers to the use of electronic services to support a broad range of remote services, such as patient care, education, and monitoring. Telehealth must be integrated into traditional ambulatory and hospital-based practices if it is to achieve its full potential, including addressing the six domains of care quality defined by the Institute of Medicine: safe, effective, patient-centered, timely, efficient, and equitable. Telehealth is a disruptive technology that appears to threaten traditional health care delivery but has the potential to reform and transform the industry by reducing costs and increasing quality and patient satisfaction. This article outlines seven strategies critical to successful telehealth implementation: understanding patients' and providers' expectations, untethering telehealth from traditional revenue expectations, deconstructing the traditional health care encounter, being open to discovery, being mindful of the importance of space, redesigning care to improve value in health care, and being bold and visionary.
With the advent of national health reform, millions more Americans are gaining access to a health care system that is struggling to provide high-quality care at reduced costs. The increasing adoption of electronic technologies is widely recognized as a key strategy for making health care more cost-effective. This article examines the concept of connected health as an overarching structure for telemedicine and telehealth, and it provides examples of its value to professionals as well as patients. Policy makers, academe, patient advocacy groups, and private-sector organizations need to create partnerships to rapidly test, evaluate, deploy, and pay for new care models that use telemedicine.
Objectives: The current study explored differences in acceptance of telehealth interventions amongst currently licensed and future clinicians with a focus on web camera-based intervention. The influence of theoretical orientation was also assessed. Method: An online survey assessed 717 participants comprising 409 licensed psychologists (40.8% female, mean age = 56.57, standard deviation [SD] = 11.01) and 308 doctoral-level students (78.9% female, mean age = 27.66, SD = 5.9) across domains of endorsement and rejection. Results: Binary logistic regression indicated no significant difference between currently licensed and future psychologists in their endorsement of telehealth modalities. Cognitive-behavioral, cognitive, behavioral, and systems psychologists were significantly more accepting of telehealth interventions than were dynamic/analytic or existential therapists. Conclusions: Increasing exposure to telehealth through education as well as continued research on efficacy for specific diagnoses may help psychologists to more effectively determine whether telehealth is the "best fit" for both clinician and client.