Researchers from Sidney Kimmel Medical College at Thomas Jefferson University in Philadelphia have released findings from a qualitative study that show patients reacted quite favorably to video visits scheduled with their established primary care clinicians.
In fact, all 19 patients who participated in a video visit and who were subsequently interviewed for the study expressed an interest in utilizing video visits for their future health care.
The research report, titled "Patient Perceptions of Telehealth Primary Care Video Visits,"(annfammed.org) is published in the May/June issue of Annals of Family Medicine.
The work is important and timely, said co-author Rhea Powell, M.D., M.P.H., a general internist and clinical assistant professor at Thomas Jefferson University.
Powell told AAFP News that recent changes in health care delivery "have opened up new opportunities for providers and practices to innovate in how they care for patients." She noted that telehealth, including video visits, "offers a care delivery modality that has potential to improve access and efficiency of care."
- Researchers at Thomas Jefferson University gave patients an opportunity to see their trusted primary care clinician via video visits.
- In post-visit interviews, patients said the video visits were convenient and improved their ability to communicate with their health care professional.
- One researcher said that barriers to care lead to same-day cancellations and no-shows and that video visits help ensure that patients get the follow-up care they need.
The concept is right in step with the patient-centered care model that is sweeping the country, because patients find that video visits are "convenient and improve their ability to get in touch with their health care provider," said Powell.
For the study, researchers conducted individual interviews with patients who agreed to try a video visit in place of a face-to-face office visit with their primary care provider. At the end of the video visits, patients were told they could receive a phone call from a research assistant asking for feedback about the experience.
"Our study suggests that patients may accept and even prefer video visits with established primary care clinicians," wrote the authors.
Furthermore, "Our findings expand the knowledge base about the urban use of telehealth and support the growing consensus that incorporating telehealth into primary care will allow patients to access their usual source of care more conveniently," they added.
What specifically did patients like about their video visit versus a trek to the doctor's office?
Cost and convenience were high on the list. Patients liked saving money on gas, parking and co-pays. (The authors pointed out that for the study, patient co-pays for video visits were waived.)
Patients reported decreased wait times when compared with traditional office visits. And those who participated in the video visit at their place of employment were spared absenteeism from work, although for some people without a private office, finding a space with privacy to conduct the video call was problematic.
Among other benefits to patients, the video visit eliminated battling traffic, worries about being late for the appointment and having to secure childcare.
For patients with limited mobility, not having to leave home was a big bonus.
One patient explained the video visit experience like this: "You're sitting right in your room on your computer. How much more convenient can that be? And you don't even have to take a shower. I mean you can get on the computer, talk to the doctor, go back to bed."
The patients who participated in video visits and follow-up interviews were seen for a variety of medical reasons -- nine for chronic diseases management, seven for short-term follow-up of recent acute issues, two for review of lab results and one for a new acute issue.
In a phone interview, Powell discussed other aspects of the research, including implications for health care delivery nationwide. The following Q&A reflects portions of that conversation.
Q. What is your personal interest in this topic?
A. I'm a researcher, but I also practice in a busy urban academic practice, and like many practices, I see the impact of same-day cancellations and no-shows on the availability of office appointments. That, in turn, affects our ability to care for patients in a timely manner.
So I think it's exciting that there is a way we can address some of the barriers that patients face just physically getting into the office -- from transportation barriers, parking, lost time at work -- all of these issues that patients have to balance when they're trying to figure out if they can get to the doctor's office on any given day.
Q. Can you give me an example of how video visits work really well in your practice?
A. I practice in Philadelphia and we have a big catchment area, so we have patients who are coming from as far away as New Jersey. With traffic, some of my patients have to travel for up to an hour.
So when I'm handling something that needs close follow-up over the course of a few weeks -- such as managing a patient's diabetes and titrating her insulin, or managing a patient's depression and starting him on a new antidepressant medication -- I don't always need the patient to come into the office. But I do need to have 20 minutes set aside so that the two of us can touch base, see how things are going, see how the patient is responding to any change in therapy.
Limiting the barriers to access helps ensure that patients get the close follow-up they need.
Q. Did the findings hold any surprises for you?
A. Yes, a number of patients reported they would prefer to receive serious news via a video visit instead of in person so that they could be close to home, close to loved ones, have privacy if they were upset. They wanted to be able to process information.
This is somewhat contrary to the historical recommendations that we providers have been taught -- that patients must come in to the office to receive serious news because we need to tell them face-to-face.
Q. What's the key message you'd like readers to take away from your research?
A. Our patients tell us that video visits with their primary care doctors are convenient and can be used effectively in primary care settings. Patients have a good sense of which medical conditions require in-person evaluation and which can be effectively managed via telehealth.
Patients know what they need, and we should trust them and offer them this option.
Q. What are the implications for health care delivery nationwide?
A. Delivery models should be designed to incorporate the use of telemedicine in primary care. There's lots of change going on in how we deliver care including through ACOs (accountable care organizations) and chronic care models. People are innovating and trying to figure out how to make health care convenient, high-quality and patient-centered, and that means all of these delivery models should include telehealth video visits.
Q. Where will you focus future research on this topic?
A. We need to identify the clinical scenarios in our patient populations where video visits can be used most effectively and then build out pathways to make that remote communication possible.
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