In 2020, HBHI awarded a pilot grant to Jodi Segal, MD, MPH, a HBHI Leadership Committee member and Professor of Medicine at the Johns Hopkins School of Medicine and the Bloomberg School of Public Health to understand what clinicians and patients consider to be appropriate use of telemedicine in primary care to inform future development of a framework that should be valuable to diverse stakeholders.HBHI is pleased to share that her pilot yielded two publications in the May 2022 edition of theJournal of the American Board of Family Medicine.
Segal and her teaminterviewed18 patients, clinicians, and administrators to prepare an initial framework.They were asked to discuss optimal, acceptable, and suboptimal uses of telemedicine for delivering care compared to in-person care delivery. Five main themes for telemedicine use emerged from the interview process: clinical situations which are optimal for in-person care; situations optimal for virtual visits; situations that might be exchangeable between sites; contextual factors favoring in-person care; and contextual factors favoring virtual visits.
Segal’s team obtained feedback that in-person care is optimal, for examples, when a patient has a new condition or a high-acuity situation, or when a provider needs to deliver bad news or discuss sensitive issues. One clinician remarked, “[I]f I truly don’t trust that they’re in a safe space,” then it would not be a good idea for a patient to use telemedicine and an onsite visit would be encouraged. Likewise, in-person is preferred if a patient tends to get distracted in virtual meetings or if there are privacy concerns. On the other hand, virtual appointments are best for situations where a patient poses a risk outside of the home or has mobility limitations. Specifically, when a patient mentioned, “I’m in a wheelchair, I need someone to go with me,” it presented a scenario when telemedicine provided a favorable method to overcome this barrier. Additionally, virtual visits allow for caregiver flexibility to join a patient’s visit and are less costly, which helps those having time or financial constraints. After further validation, Segal expects that this framework may guide future research and practice: it may be valuable for clinical practice redesign, for designing evaluations of the outcomes of virtual visits, for outcomes research, for patient education, for triage, and possibly for reimbursement considerations.
“Telemedicine in Primary Care: Qualitative Work Towards a Framework for Appropriate Use” and “Working Framework for Appropriate Use of Virtual Care in Primary Care” were co-authored by Stacey Davis and Vadim Dukhanin.
Jodi Segal currently serves on the HBHI Leadership Committee in addition to her myriad other roles as a professor of medicine.