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Objective: Telehealth use rapidly increased during the COVID-19 public health emergency. While this preserved safe access to care, there was insufficient time to optimize telehealth implementation for its clinical users. We sought to understand endocrinologists’ experiences with synchronous telehealth to identify factors that influence successful implementation and can promote sustained use. Methods: We conducted semi-structured qualitative interviews with a purposive sample of 26 US endocrinologists. We asked about their experiences with telehealth, administrative and organizational factors, and technology-related issues. We also asked for recommendations for supporting clinicians’ continued telehealth use post-pandemic. We used a directed content analysis and rapid coding approach to identify factors affecting telehealth experiences. We noticed close alignment with and mapped findings to the human-organization-technology fit (HOT-fit) framework, which recognizes human, organizational, and technological factors as common elements influencing health information system implementation. Results: We identified the following clinician, organizational, and technology factors from the HOT-fit framework that influenced successful use of telehealth.1) Clinician Factors: Negative attitudes towards telehealth, including resistance towards the technology or concerns that older patients struggle with it, were initial barriers to uptake. However, attitudes were malleable over time. After initial adjustment and training, most clinicians reported enjoying and seeing value in telehealth, and planned to continue using a combination of in-person and telehealth. Although many clinicians voiced fears of missing clinical issues, none reported overlooking findings that would change treatment plans. Clinicians found both benefits and burdens associated with telehealth;flexible scheduling improved work-life balance but some also noted increasing workload.2) Organizational Factors: Clinicians felt most supported in organizations that provided training and technology support for both patients and themselves, attending to technical, logistical, and clinical needs. Telehealth was less stressful when support staff were reallocated to streamline workflow with ancillary tasks. Scheduling practices affected clinician experience: mixed clinics with in-person and telehealth visits combined with overbooking often exacerbated workflow challenges. Payment policies and parity of telehealth and in-person visits were key factors encouraging clinicians’ continued telehealth use.3) Technology factors. Almost all clinicians preferred video visits over those by phone. However, clinicians sought improvements in usability and reliability of platforms for video visits and data sharing. Robust IT support in real time reduced the burden associated with using visit time to perform tech support. Conclusions: Favorable clinician perceptions of telehealth are critical for sustained use. Clinicians initially approached telehealth at varied stages of acceptance and comfort. Perceptions of telehealth can improve with personal experience and organizational efforts that address individual training needs, adequate support staffing, tech support, and efficient workflow. Further telehealth implementation strategies by policymakers and health care leaders in endocrinology should address these aspects affecting clinician experience to maximize future success in telehealth adoption and use post-pandemic.Presentation: No date and time listed
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Methods: Semi-structured interviews were conducted with 51 providers and 30 Veterans across 12 VHA Medical Centers (VAMCs). Interviewees included staff delivering and patients participating in tele WH coaching, tele WH educational classes, and tele-complementary and integrative therapies (e.g., acupuncture, chiropractic, yoga, Tai Chi, mindfulness or meditation). Interviews were transcribed and a content analysis was performed using a rapid approach. Results: Participants described a broad range of benefits associated with Veteran participation in teleWH services. These included: 1) Improved access to services that previously were not widely offered in-person;2) Increased comfort engaging in services, especially for specific Veteran populations (e.g., Veterans with PTSD, LGBTQ, women, and younger Veterans);3) Greater convenience, including less stress related to travel, length of time required to use services, and integration with workday;and 4) Increased engagement in self-care outside of classes or services. Disadvantages included: 1) Decreased socialization and opportunities for group interaction;2) Decreased access to touch-based services (e.g., acupuncture);3) Technological challenges with approved virtual platforms. Facilitator skill and tele health etiquette mattered greatly for satisfaction with tele WH. Background: The Veterans Health Administration (VHA) quickly responded to the COVID-19 pandemic by providing access to care via tele health. This rapid pivot occurred simultaneously with VHA's Whole Health transformation, which includes the integration of complementary and integrative health services, education, and coaching to develop self-care skills. This qualitative study explored providers' and patients' perspectives on the implementation and advantages/ disadvantages of tele-Whole Health services (tele WH). Conclusion: Tele WH is perceived to be a strong complement to in-person services and poses many physical and mental health benefits for patients. Attention to facilitator skills training and ease of virtual platform use is needed to increase engagement and make tele WH a viable patient centered option for care.
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Objective: In recent years, the Veteran's Health Administration (VA) has been engaged in a large-scale transformation towards a Whole Health System (WHS) model of care. Major shifts include moving from a disease-focused model to one that incorporates complementary and patient-centered approaches to improve overall health and well-being. A key component of this model is supporting employee well-being. The SARS-CoV-2 pandemic disrupted VA healthcare systems and increased stress and anxiety for employees. This study sought to examine how VA's WHS transformation efforts intersected with its SARSCoV- 2 pandemic response. Methods: A single, multi-person qualitative interview was conducted at each of the 18 VA Medical Centers as part of an ongoing, multi-year evaluation of WH transformation. Sixty-one Whole Health leaders and staff participated in the interviews that focused on how WH transformation had been affected by the SARS-CoV-2 disruption and how WH was used to support employee needs during the pandemic. We used a rapid approach to conduct a directed content analysis, using a priori and emergent categories. Results: While the pandemic initially slowed organizational and cultural transformation efforts, medical centers intentionally embraced a Whole Health approach to support employees during this crisis. These efforts included promoting complementary and integrative Health (CIH) therapies and WH concepts to combat stress. Sites supported employee well-being by offering an extensive variety of self-care activities for staff. The need for stress-reducing supports elevated the perceived value of the WHS, generating endorsement from hospital leadership. Conclusion: At a time of crisis, most sites leaned into Whole Health, using it as a key strategy to support employee well-being. This demonstrates the promise of using a WH approach for addressing stress and anxiety in health care workers. Additionally, aligning ongoing transformation efforts with immediate crisis-related needs can help ensure continued progress even while organizational priorities may temporarily lie elsewhere.