Barriers to telehealth: The patient perspective

ABSTRACT

Background: During the COVID-19 pandemic, the need for telehealth has come to the forefront of healthcare. In the right clinical context, telehealth is an easy and effective way for providers to deliver high quality care, while also taking away barriers to care access such as clinic inconvenience, distance traveled, financial toxicity, etc. An abundance of data exists regarding the benefits and potential of telehealth, but most data is from the perspective of the provider. Unfortunately, there is little information regarding the patient's perspective and satisfaction;and even less regarding accessibility issues in terms of technology and cultural perception of telehealth. We postulate that there is a need for individualized grass root level understanding of the population being served to make sure telehealth adoption is sustained and equitable. We are studying this using a rapid cycle improvement project using a Plan Do Study Act format (PDSA), with a cohort of veterans in a medical oncology clinic in Birmingham, AL. Methods: We spoke with a pilot cohort of 67 patients in the medical oncology clinic at the VA Medical Center in Birmingham, AL. Surveys were done on all patients prior to their initial telehealth visit. Patients first agreed to participate, and then answered a 6-question survey regarding their perception of telehealth, their willingness to participate, and their perceived barriers to participation. We then identified barriers to intervene upon, with the plan to engage senior VA Leadership for the same. Results: 67 medical oncology patients in the Birmingham VA between May 1 and May 31, 2020, agreed to participate in a survey prior to their first telehealth appointment. We found that of the 67 patients surveyed, only 48 (71.6%) had a video capable phone and only 41 (61.2%) had high-speed internet or data to support that call. Interestingly 25 patients (37%) did not feel they could access the video on their own phone. While this presented one barrier to telehealth, we also found that 11 patients (16.4%) would not want to participate in telehealth even if they had a video capable device. Conclusions: This data, while not exhaustive, clearly captures some unique barriers to telehealth that may not have been previously studied or understood. Hearing the voice of the patient is critical in developing culturally competent forms of telehealth delivery. We will use this data to implement interventions that not only provide access of technology for our patients but will also make sure to specifically address the cultural/socioeconomic barriers to this form of healthcare distribution and how to overcome those barriers.