ABSTRACT
Rationale: The field of sleep medicine has been an avid adopter of telehealth, particularly during the COVID-19 pandemic. While numerous randomized trials support the efficacy of telehealth to treat conditions such as obstructive sleep apnea (OSA) and insomnia, relatively little is known about patients' experiences and perceptions of telehealth in typical practice. Methods: We recruited a purposive sample of patients who had sleep provider encounters via one of three telehealth modalities: in-clinic video, home-based video, and telephone. We conducted semi-structured interviews to assess general telehealth experiences, elicit perceptions around most and least helpful aspects, and contrast their experiences with in-person care. Two analysts coded transcripts using content analysis. After review of coding and categorization, the analysts identified emergent themes that cut across participants and categories. Results: We conducted interviews with 35 patients (in-clinic video n=12, home-based video n=11, telephone n=12) at two VA medical centers from June 2019 to May 2020. Five themes emerged including access to care, security and privacy, personalization of care, patient empowerment, and unmet needs. 1) Access to care: Patients perceived that telehealth provided access to sleep care in a timely and convenient manner, especially during the COVID-19 pandemic. Patients also saw telehealth as a way to improve continuity of care with their preferred providers. 2) Security and Privacy: Patients described how home-based telehealth afforded them greater feelings of safety and security within appointments due to avoidance of anxiety provoking triggers (e.g. crowds). However, patients also noted a potential loss of privacy when telehealth was delivered at home. 3) Personalization of care: Patients outlined ways in which telehealth both improved and hindered their ability to communicate their individual needs to providers. In turn, this communication translated into the delivery of personalized care and positive health impacts. 4) Patient Empowerment: Patients described how telehealth empowered them to engage in self-management for their sleep disorders. 5) Unmet Needs: Patients recognized that there were specific areas where telehealth was not meeting their needs, including lack of follow-through with PAP therapy. Patients also expressed concerns around the lack of a physical examination. Conclusion: Patients described both positive and negative experiences with telehealth, highlighting areas where care can be further adapted to better suit their needs. As we continue to refine telehealth practices, we encourage providers and hospital systems to consider these aspects of the patient experience.