2023 HSR&D/QUERI National Conference

4052 — Perceptions and use of telehealth among mental health and primary and specialty care providers during the COVID-19 pandemic

Lead/Presenter: Samantha Connolly,  COIN - Bedford/Boston
All Authors: Connolly SL (Center for Healthcare Organization and Implementation Research, Boston; Harvard Medical School, Boston), Miller CJ (Center for Healthcare Organization and Implementation Research, Boston; Harvard Medical School, Boston) Gifford AL (Center for Healthcare Organization and Implementation Research, Boston; Boston University School of Medicine, Boston) Charness ME (VA Boston Healthcare System, Boston; Harvard Medical School, Boston; Boston University School of Medicine, Boston)

Provider attitudes toward telehealth care delivered via video or audio-only phone visits may impact utilization rates, and findings may differ based on specialty. The objective of this survey study was to examine whether provider beliefs regarding telehealth quality and ease of use corresponded with the proportion of care delivered via video, phone, and in-person across specialties.

We conducted a voluntary, anonymous survey from August-September 2021. Participants were mental health (MH), primary care (PC), and specialty care (SC) providers across the eight medical centers comprising the VA New England Healthcare System (VISN 1). The 32-item survey assessed the relative quality of video, phone, and in-person care; factors contributing to providers’ modality choice; telehealth challenges; and provider modality preferences when treating new and established patients. We then assessed the number of completed outpatient visits during August-September 2021 across specialties, both within VISN 1 and nationally, via the VA Corporate Data Warehouse. Within each specialty (MH, PC, and SC), visits were sorted based on encounter type: video, phone, and in-person. We then examined whether survey responses across specialties corresponded with respective utilization rates of video, phone, and in-person care.

There were 866 survey respondents (estimated 64% response rate); fifty-two respondents reported no video or phone use in the three months prior to survey completion and were excluded, resulting in a final sample of 814. Respondents were divided among MH (49.5%), PC (18.8%), and SC (31.7%), and included physicians (40.2%), psychologists (24.2%), social workers (13.1%), nurse practitioners (12.9%), physician assistants (4.3%), pharmacists (4.2%), and podiatrists (0.6%). Compared with PC and SC providers, MH providers rated the quality of video care the highest (Chi-squared tests >40.2, ps < .001) and were more likely to prefer video over phone when seeing patients remotely (Chi-squared tests >15.8, ps < .001). PC and SC providers were more likely to rate phone as being at least equivalent in quality to video (Chi-squared tests >13.3, ps < .01). They were also more likely to endorse challenges using the VA’s videoconferencing platform, VA Video Connect (VVC), including patient difficulties connecting and a lack of technical support for patients (Chi-squared tests >58.2, ps < .001). Most (>60.6%) PC and SC providers either had no preference or preferred phone for remote care of established patients. Findings aligned with utilization rates within VISN 1 and across VA nationally, with MH providers conducting significantly more video care than PC and SC providers.

Provider attitudes regarding telehealth quality and ease of use corresponded strongly with utilization rates. Moving forward, provider utilization of telehealth may be impacted by additional data regarding the relative effectiveness of modalities as well as improvements in video telehealth workflows.

Results were presented to national VA Office of Connected Care (OCC) leadership. Findings of continued difficulties using VVC, particularly among PC and SC providers, in part informed OCC’s decision to extend its contract with a private videoconferencing platform to be used as a backup in the case of VVC failure.