Implementation of Video-based Care in Interdisciplinary Primary Care Settings at the Veterans Health Administration: Perspectives from Patients, Clinicians and Staff (Preprint)

Abstract

With the rapid shift to telehealth, there remains a knowledge gap in how perspectives regarding video-based care differ among interdisciplinary primary care (PC) team members and patients.

The objective of this study is to gain an in-depth understanding from both interdisciplinary primary care team members and patients about factors associated with the implementation of video-based care at the Veterans Health Administration (VA) two years after the onset of COVID-19.

From 2022-2023, a total of 43 PC staff and 25 patients were interviewed. PC staff included: 16 physicians, 12 nurses, 3 clinical pharmacists, 3 social workers, 2 mental health specialists, 4 schedulers/clerks, and 3 leadership personnel. A purposive sampling strategy was used to recruit PC staff and patients from 12 VA medical centers with varying rates of video use in different geographical regions (rural and urban) to participate in 30-minute virtual interviews. The five domains from the Diffusion of Innovation Theory and the Non-Adoption, Abandonment, Scale-up, Spread, and Sustainability (NASSS) framework guided the development of the interview guide. Directed-content rapid analysis of the interview transcripts identified factors influencing PC staff and patients’ experiences with video-based care, using a priori five NASSS domains (patient condition/characteristic, technology, adopter system, healthcare organization, adaptation over time).

Informed by the NASSS domains, the main factors associated with implementation of video-based care were: 1) Patient’s health/medical conditions (e.g., bed-bound, illness acuity), non-medical challenges to physically accessing the clinic (e.g., lengthy travel time, transportation barriers, housing status); 2) Usability of video platform, patient and provider’s knowledge of using video-enabled technology; 3) Virtual care coordination that mimics in-person care (e.g., the nurse initiates the video visit before the physician joins the call), integration of caregivers during video visits; 4) Leadership support at all levels, hands-on/on-site trainings for all (staff/patients/caregivers), consistent scheduling practices; 5) Additional telehealth resources and support, adaptability of technological advances.

By applying the NASSS framework, this study systematically examined and identified key factors associated with the implementation of video-based services in primary care integrated clinics at the VA. Multifaceted factors identified in this study may inform recommendations on how to sustain and improve video-based care implementation in VA primary care settings, as well as non-VA patient-centered medical homes.