Telemedicine Adoption During COVID-19 Pandemic: Perspectives from Primary Care Clinicians in Safety-Net Settings

• Published in: Journal of the American Board of Family Medicine Vol. 37; no. 3; pp. 409 - 417
• Main Authors: Nkodo, Amelie Foumena, Gonzalez, Martha M., Reves, Sarah, Etz, Rebecca S.
• Format: Journal Article
• Language: English
• Published: United States 01.05.2024
• Subjects: Adult; Attitude of Health Personnel; COVID-19 - epidemiology; Female; Health Services Accessibility - organization & administration; Humans; Male; Pandemics; Physicians, Primary Care - statistics & numerical data; Primary Health Care - organization & administration; Safety-net Providers - organization & administration; SARS-CoV-2; Surveys and Questionnaires; Telemedicine - organization & administration; Telemedicine - statistics & numerical data; United States; United States; COVID-19; Primary Health Care; Pandemics; Telemedicine; Safety-Net Clinics; Health Services Research
• ISSN: 1557-2625; 1558-7118; 1558-7118
• DOI: 10.3122/jabfm.2023.230339R1

The objective of this study is to describe the facilitators and barriers of telemedicine during the COVID-19 pandemic for primary care clinicians in safety-net settings. We selected 5 surveys fielded between September 2020 and March 2023 from the national "Quick COVID-19 Primary Care Survey" by the Larry A. Green Center, with the Primary Care Collaborative. We used an explanatory sequential mixed method approach. We compared safety-net practices (free & charitable organization, federally qualified health center (FQHC), clinics with a 50% or greater Medicaid) to all other settings. We discuss: 1) telemedicine services provided; 2) clinician motivations; 3) and telemedicine access. All clinicians were similarly motivated to implement telemedicine. Safety-net clinicians were more likely to report use of phone visits. These clinicians felt less "confident in my use of telemedicine" (covariate-adjusted OR = 0.611, 95% CI 0.43 - 0.87) and were more likely to report struggles with televisits in March 2023 (covariate-adjusted OR = 1.73, 95% CI 1.16 - 2.57), particularly with physical examinations. Safety-net clinicians were more likely to endorse reductions in no-shows (covariate-adjusted OR = 1.77, 95% CI 1.17 - 2.68). Telemedicine increased access and new patient-facing demands including portal communications. This study enhances our understanding of the use of telemedicine within the safety-net setting. Clinician perceptions are important for identifying barriers to telemedicine following the end of the Federal COVID-19 Public Health Emergency. Clinicians highlighted significant limitations to its use including clinical appropriateness, quality of physical examinations, and added patient-facing workload.