IS TECH-EQUITY POSSIBLE? RURAL PATIENT AND CLINICIAN PERSPECTIVES ON VIDEO VISITS IN PRIMARY CARE

ABSTRACT

BACKGROUND: The rapid shift to telehealth during COVID-19 amplified inequities in video-based healthcare. Reduced use of video visits among historically marginalized populations may exacerbate existing healthcare access disparities. We explored patient and provider insights with primary care video visits. Due to concerns that the promotion of video visits could worsen access to care among marginalized populations, we centered our work on rurald welling African Americans. METHODS: We conducted 4 video-based focus groups (n = 38) with rural VA primary care teams and 24 semi-structured telephone interviews with rural-dwelling African American Veterans purposively sampled by video-visit experience (14 with video visit experience and 12 without). Data collection occurred January -May 2021. Data collection guides were based on the domains from the Fortney et al. 2011 model of access to telehealth. We used a rapid analytic approach to identify themes relevant to access to video-based primary care. RESULTS: Findings clustered within three domains related to video-based care perceived access to care, satisfaction with care, and attitudes towards care. Perceived access Some patients noted differential treatment by personal characteristics (eg, race, health condition) within the health care setting though not specifically related to telehealth. Reported barriers to video visits included a lack of proper equipment and comfort with technology. Patients noted that scheduling video-based appointments was easy. Clinicians noted that video visits were inappropriate for new patient encounters or for certain conditions (eg, cognitive impairment, significant sensory impairment, new/non-specific symptoms). Satisfaction Patients appreciated the lower cost and travel times associated with video visits and some felt video visits were less rushed. However, multiple patients expressed concerns about poor quality care via video. Specifically reported were the impersonal feel of video-based care, distracted providers, and inability to fully assess patient concerns. Providers reported frequently spending significant time managing technical malfunctions and diminished interpersonal connections via video. Attitudes Despite the logistical convenience, many patients noted a preference for in-person care due to perceived higher quality and general appeal of the ritual of going in-person for care. Patients wanted the choice of in-person vs remote care rather than being told which they would receive. Clinical teams were open to video-based visits but emphasized the importance of considering clinical appropriateness and the need for adaptation of clinic workflow to the needs of virtual care (eg, a pre-visit online check-in). CONCLUSIONS: Optimal and equitable incorporation of virtual modalities into primary care requires an assessment of clinical appropriateness of videobased care as well as patient preference and technological readiness at each visit.