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Barriers and facilitators to implementing telehealth services during the COVID-19 pandemic: A qualitative analysis of interviews with cystic fibrosis care team members.
Van Citters, Aricca D; Dieni, Olivia; Scalia, Peter; Dowd, Christopher; Sabadosa, Kathryn A; Fliege, Jill D; Jain, Manu; Miller, Robert W; Ren, Clement L.
  • Van Citters AD; The Dartmouth Institute for Health Policy & Clinical Practice, Geisel School of Medicine at Dartmouth, Williamson Translational Research Building, Level 5, One Medical Center Drive, Lebanon, NH, 03766, USA. Electronic address: Aricca.D.Van.Citters@Dartmouth.edu.
  • Dieni O; Cystic Fibrosis Foundation, 4550 Montgomery Avenue, Suite 1100N, Bethesda, MD 20814 USA.
  • Scalia P; The Dartmouth Institute for Health Policy & Clinical Practice, Geisel School of Medicine at Dartmouth, Williamson Translational Research Building, Level 5, One Medical Center Drive, Lebanon, NH, 03766, USA.
  • Dowd C; Cystic Fibrosis Foundation, 4550 Montgomery Avenue, Suite 1100N, Bethesda, MD 20814 USA.
  • Sabadosa KA; Cystic Fibrosis Foundation, 4550 Montgomery Avenue, Suite 1100N, Bethesda, MD 20814 USA.
  • Fliege JD; Adult Cystic Fibrosis Nurse Practitioner / Program Coordinator; Pulmonary, Critical Care, Sleep and Allergy Medicine, 985990 Nebraska Medicine, Omaha, NE, 69198-5990, USA.
  • Jain M; Division of Pulmonary and Critical Care Medicine, Department of Medicine, Feinberg School of Medicine, Northwestern University, Chicago, IL, 60611, USA.
  • Miller RW; Lehigh Valley Reilly Children's Hospital Cystic Fibrosis Center, 1210 Cedar Crest Blvd, Suite 2700, Allentown, PA, 18103, USA.
  • Ren CL; Children's Hospital of Philadelphia, Division of Pulmonary and Sleep Medicine, Colket Translational Research Building, 3501 Civic Center Blvd, Philadelphia, PA, 19104, USA; Department of Pediatrics, Perelman School of Medicine, University of Pennsylvania, Philadelphia, PA, 19104, USA.
J Cyst Fibros ; 20 Suppl 3: 23-28, 2021 12.
Article in English | MEDLINE | ID: covidwho-1587339
ABSTRACT

BACKGROUND:

The COVID-19 pandemic forced cystic fibrosis (CF) care programs to rapidly shift from in-person care delivery to telehealth. Our objective was to provide a qualitative exploration of facilitators and barriers to 1) implementing high-quality telehealth and 2) navigating reimbursement for telehealth services.

METHODS:

We used data from the 2020 State of Care CF Program Survey (n=286 U.S. care programs) administered in August-September to identify two cohorts of programs, with variation in telehealth quality (n=12 programs) and reimbursement (n=8 programs). We conducted focus groups and semi-structured interviews with CF program directors and coordinators in December 2020, approximately 9 months from onset of the pandemic. We used the Consolidated Framework for Implementation Research to identify facilitators and barriers of implementation, and inductive thematic analysis to identify facilitators and barriers of reimbursement.

RESULTS:

Factors differentiating programs with greater and lower perceived telehealth quality included telehealth characteristics (perceived advantage over in-person care, cost, platform quality); external influences (needs and resources of those served by the CF program), characteristics of the CF program (compatibility with workflows, relative priority, available resources); characteristics of team members (individual stage of change), and processes for implementation (engaging patients and teams). Reimbursement barriers included documentation to optimize billing; reimbursement of multi-disciplinary team members, remote monitoring, and telephone-only telehealth; and lower volume of patients.

CONCLUSIONS:

A number of factors are associated with successful implementation and reimbursement of telehealth. Future efforts should provide guidance and incentives that support telehealth delivery and infrastructure, share best practices across CF programs, and remove barriers.
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Full text: Available Collection: International databases Database: MEDLINE Main subject: Patient Participation / Telemedicine / Communication Barriers / Disease Transmission, Infectious / Cystic Fibrosis / COVID-19 / Health Services Accessibility Type of study: Clinical Practice Guide / Prognostic study / Qualitative research / Randomized controlled trials Limits: Adult / Child / Humans Country/Region as subject: North America Language: English Journal: J Cyst Fibros Year: 2021 Document Type: Article

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Full text: Available Collection: International databases Database: MEDLINE Main subject: Patient Participation / Telemedicine / Communication Barriers / Disease Transmission, Infectious / Cystic Fibrosis / COVID-19 / Health Services Accessibility Type of study: Clinical Practice Guide / Prognostic study / Qualitative research / Randomized controlled trials Limits: Adult / Child / Humans Country/Region as subject: North America Language: English Journal: J Cyst Fibros Year: 2021 Document Type: Article