Our Iceberg is Melting: A qualitative review of barriers to accessing televideo appointments during the SARS-CoV-2 pandemic

Samuel Scott, MD

Cambridge Health Alliance
Our Iceberg is Melting: A qualitative review of barriers to accessing televideo appointments during the SARS-CoV-2 pandemic

Scientific Abstract

Background: At the beginning of the pandemic, payers reimbursed telephone appointments at the same rate as video appointments, although it was widely accepted that video appointments resulted in the highest quality of care. In order to provide the highest standard of care to all patients, and to prepare for the inevitable change in reimbursement, it was imperative to evaluate barriers to access and completion of video visits.

Methods: Key stakeholders in the telepsychiatry workflow were identified as individual providers, patients, administrators, and scheduling personnel. Brief interviews were conducted by phone with a total of 19 stakeholders including 10 psychiatrists, 5 patients, 1 psychologist, 1 administrator, and 2 schedulers about their experiences navigating the telepsychiatry workflow. Responses were reviewed for common themes.

Results: Patient feedback to the transition ranged from seamless to having difficulty for several reasons including poor internet access, limited privacy, limited access to devices at home, or poor digital literacy. Schedulers reported giving patients the option of a phone versus a video appointment and felt it was the provider’s role to discuss with the patient and family which would be used going forward. Providers’ experiences and concerns with working in the telepsychiatry modality largely fell into two categories: decreased time per patient and provider burnout.

Conclusion: We share common goals for the population we serve, including promoting equity and connectedness for our patients, both of which require good access to video telehealth.

Access to video telehealth promotes such equity and connectedness, and we have identified urgent needs of staff and patients during this time of stress, uncertainty, and rapid change. Our qualitative data can be utilized to help inform the means of facilitating improved access to video telehealth.

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research Areas

Authors

Samuel Scott, MD, Stephanie Fosbenner, MD, MSc, Brigitta Miyamoto, MD, Saneliso Masuku, MD, Shawn Yehudian, MD, Shireen Cama, MD, Lee Robinson, MD