Download - RGC Telehealth, Megan Coffman - SLC 2015
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Robert Graham Center:Family Physician Characteristics, Attitudes, and Beliefs Regarding
Implementing Telehealth Services
Megan Coffman, MS
November 7, 2015
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Robert Graham Center The Robert Graham Center aims to improve individual and population healthcare delivery
through the generation or synthesis of evidence that brings a family medicine and primary care perspective to health policy
deliberations from the local to international levels.
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Robert Graham Center – Who We Are
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Research Topics
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Mapping Tools
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Some Recent Work
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The Project • The State of Telehealth in Primary Care
– Literature Review– Expert Panel– Survey of Family Physicians
Funded by Anthem,Inc.
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What is Telehealth?• Telehealth: the exchange of medical
information from one location to another via electronic communications
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Why Telehealth? • Telehealth is shown to:
– expand patients access to care, – increase continuity of care, – improve coordination of care – reduce healthcare costs, and – improve health outcomes
• Some indication of low usage in primary care
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Highlights from the Literature Review and Expert Panel
• There is very little research on telehealth in primary care
• The literature indicates that patients appreciate the convenience of access to telehealth services, and are satisfied with the care they receive remotely
• Patients see saving time and travel as benefits of telehealth compared to in-person care
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Survey Objectives• Measure penetration of telehealth into primary care
setting– Hypothesis: low penetration
• Characterize Family Physicians (FPs) who use telehealth– Hypothesis: higher use in rural setting, larger practices,
and younger physicians• Investigate Attitudes/Beliefs of FPs regarding
telehealth– Hypothesis: Users have more favorable attitudes/beliefs
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Who did we ask? • Survey of 5,000 randomly selected FPs
– AMA Physician Masterfile (2014) linked to AAFP member list
– FPs in direct patient care– Oversample rural 2:1
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The Survey
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Survey Questions• All Respondents
– Provider Characteristics– Practice Characteristics– Attitudes About Telehealth (Likert Scales)
• Users/Non-Users Separate– Use of Telehealth (users only)– Beliefs About Telehealth (similar but distinct)
(Likert Scales)
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Telehealth DefinedTelehealth services defined as:
1. Primary care services: a physician providing care for a patient via live interactive video and/or
2. Primary care and specialist referral services: a primary care provider consulting with a specialist via live interactive video and/or
3. Store and Forward: sharing electronic patient data between a primary care provider and specialist across locations
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Survey Data• 1,557 survey responses were analyzed
– 1,630 surveys were returned (31% response rate)– 53 surveys were returned but not used
• Non-unique ID• Respondent indicated they did NOT engage in direct
patient care or did not answer this question
• Sample weights were used to ensure the estimates computed were representative of family physicians across the United States
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Results: Demographics• 15% had used telehealth services in the last 12
months (85% had NOT) (N=225)• Telehealth users were more likely to
– rural setting (26% versus 12%, p<0.01)– use an EHR (97% vs. 92%, p<0.01)– work with six+ FPs (40% vs. 29%, p<0.01)
• Telehealth users were less likely to:– work in a practice that is privately owned (22% versus
39%, p<0.01) – Provide general primary care (76% vs. 86%, p<0.01)
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Prevalence of Telehealth Use by Type of Service Used
Source: Robert Graham Center Analysis of 2014 AAFP Telehealth Survey of Family Physicians, N=225
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Administrative Purpose
Other
Emergency Care
Second Opinion
Follow-Up
Chronic Disease Management
Diagnoses or Treatment
6%
13%
16%
20%
21%
26%
55%
Percent of Telehealth Users Who Indicated Each Reason for Use
Source: Robert Graham Center Analysis of 2014 AAFP Telehealth Survey of Family Physicians, N=225
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Results: Attitudes and Beliefs
• Telehealth users and non-users agree:– Telehealth improves access to care for my
patients. (89% users vs. 77% non-users, p<0.01)
– Telehealth improves the continuity of care for my patients. (75% vs. 68%, p<0.01)
– Patients prefer to see their doctor in person. (83% vs. 94%, p<0.01)
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Results: Barriers• Which of the following are barriers to using
telehealth in your practice? – Cost of equipment (35% users vs. 47% non-
users)– Lack of training about how to use telehealth in a
family medicine practice (40% vs. 55%)– Reimbursement by insurers (46% vs. 54%)– Potential liability issues associated with the use
of telehealth (26% vs. 41%)
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Barriers to Using Telehealth
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Limitations• Survey Biases: Self-reported response &
recall (esp. in terms of frequency of use)• Response rate of 31% and small sample
of telehealth users• Close ended questions – with opened
“other” options
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Discussion• FPs see telehealth as enhancing access
to care and improving continuity of care• Barriers impeding use are policy amenable
– offer new opportunities for training – address implementation costs– increase awareness of current reimbursement– develop new ways to reimburse
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Survey Study Conclusion• FPs views of telehealth are generally
positive• Barriers to larger adoption remain• Small but significant number of family
physicians who are providing telehealth services for patients
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What’s Next? • A survey of Blue Cross, Blue Shield
patients in California and Ohio measuring patient satisfaction
• A survey of Family Medicine Residency Directors
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Thank You and More • To learn more about the Robert Graham
Center’s work, visit our website: http://www.graham-center.org/rgc/home.html
• If you have specific questions on the telehealth project, email me at: