Primary care practices identify improvements needed for telemedicine

Qualitative data provided by 87 primary care practices in New York and Florida revealed that telehealth experiences differed based on familiarity with pre-pandemic physician and virtual care platforms, with varying state-by-state differences during the public health emergency. Regulations, lack of formal guidelines and burnout of physicians affected how quickly telemedicine offerings matured within practices.

why it matters

To identify common facilitators and barriers to telehealth implementation, researchers assessed practice leaders’ perspectives on 32 aspects of telemedicine, according to a new report. Annals of Family Medicine,

Participating primary care practices, all part of the Patient-Centered Outcomes Research Institute’s clinical research network, were either general, family, ambulatory internal medicine, preventive medicine or geriatric medicine practices. He himself identified his point of maturity.

Not unexpectedly, according to the report “Telemedicine Experience in Primary Care Practices in the United States: Insights from Practice Leaders,” ease of adoption depends on prior experience with virtual health.

Practices with already established telemedicine programs did not face the same adaptation challenges as their counterparts launching new virtual care programs. However, the scheduling of visits was “a widely cited acute problem.”

Physicians said it was frustrating to jump from in-person to telehealth and back — and noted that patients were less tolerant of waiting for a virtual appointment, the researchers said. She also said that physicians reported a need for more formal training on a virtual platform and on how to communicate more effectively about state regulation.

Regulations that varied widely also affected their use of telehealth platforms. For example, Florida’s “highly specific emergency order that limited controlled substance prescribing only to preexisting patients” was a common theme in the interviews, according to the researchers.

One primary care practice leader said Florida’s laws put a “monkey wrench” on telemedicine. “Patients taking controlled substances, such as testosterone, will have to come in person for refills,” he added.

Like many other states, Florida’s laws prohibit payment for asynchronous visits, restricting audio-only appointments, which respondents said limited access for older patients.

Licensing was also a moving target that could constrain the ability to treat pre-existing patients.

A third theme that emerged was the tendency for telehealth visits to be scheduled for appointment overflow rather than in an appropriate format for specific complaints.

According to the researchers, many respondents agreed that a robust triage process is needed so that physicians do not try to rule out a symptom such as acute chest pain on a telehealth visit.

Respondents noted that patient-specific factors, such as privacy preferences, may underlie visit-type decisions. They also noted that it is not clear when to send the virtual patient to emergency services.

“Even though clear guidelines for planning virtual visits are important, formal guidance is lacking,” the researchers said.

“These gaps are not trivial and represent an opportunity to significantly improve virtual health care delivery.”

A fourth theme to emerge was that telemedicine had both positive and negative effects on doctors and patients.

Jumping on a virtual journey was touted as a benefit for mental health and chronic conditions, as well as an “inequality buster” by some PCP leaders serving Medicaid and Medicare populations.

Two study respondents noted that telehealth visits provide a “billable opportunity” to reinforce and review test results after the initial visit.

However, some practices are concerned about “unequal access to care,” such as when they are setting up a patient portal for booking a virtual visit.

The study revealed mixed opinions on how telehealth affected physician burnout.

Some practice leaders pointed out that telemedicine visits were often preferred to improve access for patients with limited mobility, reduce clinical risks of infection, and provide doctors with more flexible scheduling opportunities.

Meanwhile, other respondents said doctors worked longer than normal hours, supported patient technical issues and were laid off when a virtual visit was more appropriate for a patient’s need.

One respondent said, “(Physicians) feel lonely doing telemedicine (and) say to themselves ‘I never want to do this again,’ because a full day of telehealth is challenging.”

big trend

Prior to the COVID-19 pandemic, telemedicine use was hampered by reimbursement concerns and a lack of regulation. But the telehealth boom during the pandemic proved that virtual primary care inspires many value-ads.

Virtual Care is primary care reimagined by Rob Bressler, Senior Vice President of Primary360 at Teladoc Health. Telemedicine is a tool that helps create longitudinal care plans that foster lasting relationships between patients and providers, provide continuous care team support and can provide an integrated whole-in-person experience.

“The promise of delivering quality primary care in a more consumer-friendly and cost-effective manner, combined with the anticipated PCP shortage, indicates that demand for virtual primary care will increase significantly over the next few years,” he said. Healthcare IT News Last year.

On the record

“Arguably the most salient — and potentially transformative — finding was the noted need for telemedicine triage rules,” the researchers said.

Andrea Fox is a senior editor for Healthcare IT News.
Email: afox@himss.org
Healthcare IT News is a HIMSS Media publication.