rgc telehealth, megan coffman - slc 2015
TRANSCRIPT
Robert Graham Center:Family Physician Characteristics, Attitudes, and Beliefs Regarding
Implementing Telehealth Services
Megan Coffman, MS
November 7, 2015
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.
Robert Graham Center – Who We Are
Research Topics
Mapping Tools
Some Recent Work
The Project • The State of Telehealth in Primary Care
– Literature Review– Expert Panel– Survey of Family Physicians
Funded by Anthem,Inc.
What is Telehealth?• Telehealth: the exchange of medical
information from one location to another via electronic communications
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
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
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
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
The Survey
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)
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
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
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)
Prevalence of Telehealth Use by Type of Service Used
Source: Robert Graham Center Analysis of 2014 AAFP Telehealth Survey of Family Physicians, N=225
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
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)
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%)
Barriers to Using Telehealth
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
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
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
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
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: