How can equitable video visit access be delivered in primary care? A qualitative study among rural primary care teams and patients

Karen M Goldstein, Kathleen R Perry, Allison Lewinski, Conor Walsh, Megan E Shepherd-Banigan, Hayden B Bosworth, Hollis Weidenbacher, Dan V Blalock, Leah L Zullig, Karen M Goldstein, Kathleen R Perry, Allison Lewinski, Conor Walsh, Megan E Shepherd-Banigan, Hayden B Bosworth, Hollis Weidenbacher, Dan V Blalock, Leah L Zullig

Abstract

Objective: The COVID-19 pandemic sparked exponential growth in video visit use in primary care. The rapid shift to virtual from in-person care exacerbated digital access disparities across racial groups and rural populations. Moving forward, it is critical to understand when and how to incorporate video visits equitably into primary care. We sought to develop a novel clinical algorithm to guide primary care clinics on how and when to employ video visits as part of care delivery.

Design: Qualitative data collection: one team member conducted all patient semistructured interviews and led all focus groups with four other team members taking notes during groups.

Setting: 3 rural primary care clinics in the USA.

Participants: 24 black veterans living in rural areas and three primary care teams caring for black veterans living in rural areas.

Primary and secondary outcome measures: Findings from semistructured interviews with patients and focus groups with primary care teams.

Results: Key issues around appropriate use of video visits for clinical teams included having adequate technical support, encouraging engagement during video visits and using video visits for appropriate clinical situations. Patients reported challenges with broadband access, inadequate equipment, concerns about the quality of video care, the importance of visit modality choice, and preferences for in-person care experience over virtual care. We developed an algorithm that requires input from both patients and their care team to assess fit for each clinical encounter.

Conclusions: Informed matching of patients and clinical situations to the right visit modality, along with individual patient technology support could reduce virtual access disparities.

Keywords: GENERAL MEDICINE (see Internal Medicine); PRIMARY CARE; Telemedicine.

Conflict of interest statement

Competing interests: AL reports receiving funds from PhRMA Foundation and Otsuka. Hayden Bosworth reports research funding through his institution from BeBetter therapeutics, Boehringer Ingelheim, Improved Patient Outcomes, Merck, NHLBI, Novo Nordisk, Otsuka, Sanofi, VA. He also provides consulting services for Abbott, Novartis, Sanofi, Vidya, Walmart, Webmed. He is also on the board of directors of Preventric Diagnostics. LLZ reports research funding awarded to her institution from the PhRMA Foundation and Proteus Digital Health, as well as consulting for Pfizer and Novartis, all unrelated to the current work.

© Author(s) (or their employer(s)) 2022. Re-use permitted under CC BY-NC. No commercial re-use. See rights and permissions. Published by BMJ.

Figures

Figure 1
Figure 1
Algorithm development process.
Figure 2
Figure 2
Clinical support algorithm for incorporation of video visits into primary care workflow.

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