Perceptions of Adult Patients Accessing Telehealth in an Urban Medical Group

Healthy People 2020 identifies the increasing use of telehealth for delivering healthcare as one of three specific areas to be monitored in the leading health indicator of access. Telehealth has the potential to improve three identified barriers to access: insurance coverage, geographic availability, and timeliness of care. Due to changing demographics with decreasing numbers of healthcare providers and specialists and increasing numbers in the aging population, it becomes imperative to provide quality access in a sustainable model of care. Increasingly nurses use various telehealth technologies to deliver healthcare services; however, there has been a lag in research and generation of empirical knowledge to support nursing practice in this expanding field. Additional information is needed to understand how patient choice drives satisfaction in their decision to use telehealth.

Purpose: This study (in progress - results available March 2019) is soliciting the patient perspective and experience with telehealth, including their decision-making process for how, when, and why they decide to use one of multiple telehealth options or decide to schedule a standard office visit. The setting is the primary care practice within a physician-owned multi-disciplinary urban medical group with four locations in Orange County, California. The medical group offers concierge services consisting of telephone visits, video visits, secure texting and email, “mouse calls” (after-hours web page form completion with physician call back), and DIY appointment scheduling including self-ordering lab or ancillary services.

Method: This qualitative study is both exploratory and descriptive to gain an understanding from the patient’s perspective for accessing healthcare when a telehealth option is available. Semi-structured interviews with individuals one-on-one and in focus groups will be transcribed and analyzed according to Glaserian grounded theory design. An iterative approach to analysis using constant comparative coding of the data will be followed by selective coding to identify pertinent variables that emerge from the core category of patient perceptions.

Implications: Telenursing is already used in home health, remote monitoring, chronic care case management, and support of family caregivers, with legal and regulatory changes underway for expansion into other ambulatory areas. With the patient-centered experience becoming part of performance-based compensation, certification and licensing, and practice recognition, incorporating patient experiences and perceptions of telehealth will provide nurses with new insights for delivering empathic virtual care. Understanding where gaps exist in the patient experience will allow new approaches to providing an excellent telehealth experience.