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2023 HSR&D/QUERI National Conference Abstract

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1180 — Endocrinologists’ Experiences with Telehealth: a Qualitative Study with Implications for Promoting Sustained Use

Lead/Presenter: Varsha Vimalananda,  COIN - Bedford/Boston
All Authors: Vimalananda VG (Center for Healthcare Organization and Implementation Research, Bedford), Wong D (Center for Healthcare Organization and Implementation Research, Bedford) Sitter KE (Center for Healthcare Organization and Implementation Research, Bedford) Bolton RE (Center for Healthcare Organization and Implementation Research, Bedford)

Objectives:
Skyrocketing use of telehealth (synchronous video) for VA outpatient specialty care has delivered benefits including cost-savings, convenience, and improved access. But VA medical specialists have worse perceptions and lower use of telehealth than other VA providers. To preserve sustained use and benefits of telehealth post-pandemic, it is imperative to understand drivers of specialist clinician acceptance. We explored telehealth acceptance in endocrinology, which is a specialty well-suited to telehealth since it relies largely on history and labs rather than physical exam. We describe the range of concerns that VA leaders can address to promote telehealth acceptance and sustained use among specialists.

Methods:
We conducted semi-structured interviews with 26 endocrinologists across the United States. Interviews focused on experiences of adopting telehealth during the COVID-19 pandemic, probing for individual and system factors influencing experience. Using a directed-content analysis and rapid qualitative analysis we coded data into deductive categories capturing factors commonly known to influence health technology adoption and inductive categories representing additional factors. Through constant comparison we recognized alignment of our findings with the HOT-fit framework for technology implementation. We mapped our findings of clinician experience to the clinician, organization, and technology factors in this framework.

Results:
We identified the following influences on clinician acceptance. Clinician factors: 1) attitudes improved with increased telehealth experience; 2) the limitations of virtual medical care raised concerns about sustained use, and 3) telehealth affected professional and personal life balance. Organizational factors: 1) training in virtual medical care was desired; 2) staff support improved workflow efficiency; and 3) new scheduling practices were needed. Technology factors: Use was impeded by 1) usability and reliability of telehealth platforms; 2) quality of audiovisual communication, and 3) limited technical support. While some concerns were commonly expressed (e.g., unmanageable schedules that mix face-to-face and telehealth), other concerns were relevant for only a few (e.g., technical support). Many technology factors were related to the challenges of incorporating new technology into existing infrastructure.

Implications:
Endocrinologists’ acceptance of telehealth is impacted by specific and modifiable factors related to concerns about quality of care provided and work-life balance, clinic-level support for clinicians providing telehealth, and the challenges of fitting new technology into existing infrastructure.

Impacts:
Telehealth for specialty care is still new and changing; there is still an opportunity to integrate it in a way that optimizes clinician experience to support sustained use for delivery of high-quality care to Veterans. VA leadership should be flexible to successfully reconcile clinician-level needs and preferences with organizational priorities and resources. There are also implications of this study for VA leadership in the context of the rapidly advancing landscape of technology in specialty care. Rising demand for combining telehealth visits with use of patient-generated health data will pose a new set of requirements for telehealth training, scheduling, staffing, and technology. VA leadership should continue to engage with clinicians to address individual, organizational, and technological factors that influence adoption and sustainability as future telehealth advances emerge.