Will the Doctor “See” You Now? The Development and Implementation of a Targeted Telemedicine System for Primary Care

Abstract

Objectives The coronavirus disease 2019 (COVID-19) pandemic led to a rapid adoption of telehealth. For underserved populations lacking internet access, telemedicine was accomplished by phone rather than an audio–video connection. The latter is presumed a more effective form and better approximation of an in-person visit. We sought to provide a telehealth platform to overcome barriers for underserved groups to hold video visits with their health care providers and evaluate differences between the two telehealth modalities as assessed by physicians and patients.

Methods We designed a simplified tablet solution for video visits and piloted its use among patients who otherwise would have been completing audio-only visits. Patients consented to participation and were randomized in a 1:1 fashion to continue with their scheduled phone visit (control) versus being shipped a tablet to facilitate a video visit (intervention). Participants and providers completed communication and satisfaction surveys.

Results Tablet and connectivity design features included removal of all functions but for the telemedicine program, LTE always-on wireless internet connectivity, absence of external equipment (cords chargers and keyboard), and no registration with a digital portal. In total, 18 patients were enrolled. Intervention patients with video-enabled devices compared to control patients agreed more strongly that they were satisfied with their visits (4.75/5 vs. 3.75/5, p = 0.02).

Conclusion The delivered simplified tablet solution for video visits holds promise to improve access to video visits for underserved groups. Strategies to facilitate patient acceptance of devices are needed to expand the scope and potential impact of this effort.

Keywords

telemedicine - telehealth - underserved populations - primary Care - communication - patient satisfaction - communications

Publikationsverlauf

Eingereicht: 22. Dezember 2022

Angenommen: 31. August 2023

Artikel online veröffentlicht:
18. Oktober 2023

• References

• 1 Bosworth ARJ, Samson LW, Sheingold S, Taplin C, Tarazi W, Zuckerman R. Medicare beneficiary use of telehealth visits: early data from the start of COVID-19 pandemic. In: Services DoHaH, ed. Washington, DC;: 2020
• 2 Wang LY, Low TT, Yeo TJ. Telehealth in COVID-19 and cardiovascular disease-ensuring equitable care. Ann Acad Med Singap 2020; 49 (11) 902-904
• 3 Summers-Gabr NM. Rural-urban mental health disparities in the United States during COVID-19. Psychol Trauma 2020; 12 (S1): S222-S224
• 4 Ng BP, Park C. Accessibility of telehealth services during the COVID-19 pandemic: a cross-sectional survey of Medicare beneficiaries. Prev Chronic Dis 2021; 18: E65
• 5 Nouri S, Khoong EC, Lyles CR, Karliner L. Addressing equity in telemedicine for chronic disease management during the Covid-19 pandemic. Catalyst non-issue content 2020: 1
• 6 Hallie Miller MC. Maryland hospitals join other health care offices in turning to telemedicine during coronavirus fight. The Baltimore Sun 2020. Accessed September 25, 09, 2023 at: https://www.baltimoresun.com/coronavirus/bs-md-maryland-hospitals-innovation-technology-telemedicine-20200420-ajjrdxyd3zar3kxpgnakwxm22e-story.html
• 7 Demaerschalk BM. Telemedicine or telephone consultation in patients with acute stroke. Curr Neurol Neurosci Rep 2011; 11 (01) 42-51
• 8 Richter KP, Shireman TI, Ellerbeck EF. et al. Comparative and cost effectiveness of telemedicine versus telephone counseling for smoking cessation. J Med Internet Res 2015; 17 (05) e113
• 9 Voils CI, Venne VL, Weidenbacher H, Sperber N, Datta S. Comparison of telephone and televideo modes for delivery of genetic counseling: a randomized trial. J Genet Couns 2018; 27 (02) 339-348
• 10 Lion KC, Brown JC, Ebel BE. et al. Effect of telephone vs video interpretation on parent comprehension, communication, and utilization in the pediatric emergency department: a randomized clinical trial. JAMA Pediatr 2015; 169 (12) 1117-1125
• 11 Donaghy E, Atherton H, Hammersley V. et al. Acceptability, benefits, and challenges of video consulting: a qualitative study in primary care. Br J Gen Pract 2019; 69 (686) e586-e594
• 12 Vosburg RW, Robinson KA. Telemedicine in primary care during the COVID-19 pandemic: provider and patient satisfaction examined. Telemed J E Health 2022; 28 (02) 167-175
• 13 Danila MI, Sun D, Jackson LE. et al. Satisfaction with modes of telemedicine delivery during COVID-19: a randomized, single-blind, parallel group, noninferiority trial. Am J Med Sci 2022; 364 (05) 538-546
• 14 Palen TE, Price D, Shetterly S, Wallace KB. Comparing virtual consults to traditional consults using an electronic health record: an observational case-control study. BMC Med Inform Decis Mak 2012; 12: 65
• 15 Bakken S, Grullon-Figueroa L, Izquierdo R. et al; IDEATel Consortium. Development, validation, and use of English and Spanish versions of the telemedicine satisfaction and usefulness questionnaire. J Am Med Inform Assoc 2006; 13 (06) 660-667
• 16 Glaser M, Winchell T, Plant P. et al. Provider satisfaction and patient outcomes associated with a statewide prison telemedicine program in Louisiana. Telemed J E Health 2010; 16 (04) 472-479
• 17 Zulman DM, Wong EP, Slightam C. et al. Making connections: nationwide implementation of video telehealth tablets to address access barriers in veterans. JAMIA Open 2019; 2 (03) 323-329
• 18 Yang WE, Spaulding EM, Lumelsky D. et al. Strategies for the successful implementation of a novel iPhone Loaner System (iShare) in mHealth Interventions: prospective study. JMIR Mhealth Uhealth 2019; 7 (12) e16391
• 19 Medicare and Medicaid Programs. CY 2023 Payment Policies under the Physician Fee Schedule and Other Changes to Part B Payment and Coverage Policies; Medicare Shared Savings Program Requirements; Medicare and Medicaid Provider Enrollment Policies, etc. In: Services CfMM, ed. 2023: 69404-70700