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Open Access 01-12-2023 | Care | Research

Experiences with telemedicine for HIV care in two federally qualified health centers in Los Angeles: a qualitative study

Authors: Daisy Walker, Corrina Moucheraud, Derrick Butler, Jerome de Vente, Kevin Tangonan, Steven Shoptaw, Judith S. Currier, Jay Gladstein, Risa Hoffman

Published in: BMC Health Services Research | Issue 1/2023

Abstract

Background

The SARS-CoV-2 pandemic has resulted in an increase in telemedicine utilization for routine HIV care. However, there is limited information on perceptions of and experiences with telemedicine from United States (U.S.) federally qualified health centers (FQHCs) offering HIV care. We sought to understand telemedicine experiences of stakeholders with various roles: people living with HIV (PLHIV), clinical (clinicians and case managers), programmatic (clinic administrators), and policy (policymakers).

Methods

Qualitative interviews about benefits and challenges of telemedicine (telephone and video) for HIV care were conducted with 31 PLHIV and 23 other stakeholders (clinicians, case managers, clinic administrators, and policymakers). Interviews were transcribed, translated to English if conducted in Spanish, coded, and analyzed for major themes.

Results

Almost all PLHIV felt capable of engaging in telephone visits, with some expressing interest in learning how to use video visits as well. Nearly all PLHIV wanted to continue telemedicine as part of their routine HIV care, and this was also endorsed by clinical, programmatic and policy stakeholders. Interviewees agreed that telemedicine for HIV care has benefits for PLHIV, especially savings of time and transportation costs, which also reduced stress. Clinical, programmatic, and policy stakeholders expressed concerns around patients’ technological literacy and resources, as well as their access to privacy, and some felt that PLHIV strongly preferred in-person visits. These stakeholders also commonly reported clinic-level implementation challenges, including integrating telephone and video telemedicine into workflows and difficulty with video visit platforms.

Conclusions

Telemedicine for HIV care, largely delivered via telephone (audio-only), was highly acceptable and feasible for both PLHIV, clinicians, and other stakeholders. Addressing barriers for stakeholders in incorporating video visits will be important for the successful implementation of telemedicine with video as part of routine HIV care at FQHCs.

Ohannessian R, Duong TA, Odone A. Global Telemedicine Implementation and Integration Within Health Systems to Fight the COVID-19 Pandemic: A Call to Action. JMIR Public Health Surveill. 2020;6(2):e18810.CrossRefPubMedPubMedCentral

Verma S. Early Impact of CMS Expansion Of Medicare Telehealth During COVID-192020. Available from: https://www.healthaffairs.org/do/10.1377/forefront.20200715.454789/full/

Turvey C, Fortney J. The Use of Telemedicine and Mobile Technology to Promote Population Health and Population Management for Psychiatric Disorders. Current Psychiatry Reports. 2017;19(11):s11920-017-0844-0. Available from: https://link.springer.com/article/10.1007/s11920-017-0844-0.

Appuswamy AV, Desimone ME. Managing Diabetes in Hard to Reach Populations: A Review of Telehealth Interventions. Current Diabetes Reports. 2020;20(7):s11892-020-01310-2. Available from: https://link.springer.com/article/10.1007/s11892-020-01310-2.

Kruse CS, Soma M, Pulluri D, Nemali NT, Brooks M. The effectiveness of telemedicine in the management of chronic heart disease – a systematic review. JRSM Open. 2017;8(3):205427041668174.CrossRef

Comín-Colet J, Enjuanes C, Verdú-Rotellar JM, Linas A, Ruiz-Rodriguez P, González-Robledo G, et al. Impact on clinical events and healthcare costs of adding telemedicine to multidisciplinary disease management programmes for heart failure: Results of a randomized controlled trial. J Telemed Telecare. 2016;22(5):282–95.CrossRefPubMed

Association AH. Telehealth: Helping Hospitals Deliver Cost-Effective Care 2016 [Available from: https://www.aha.org/system/files/content/16/16telehealthissuebrief.pdf.

Gunter RL, Chouinard S, Fernandes-Taylor S, Wiseman JT, Clarkson S, Bennett K, et al. Current Use of Telemedicine for Post-Discharge Surgical Care: A Systematic Review. J Am Coll Surg. 2016;222(5):915–27.CrossRefPubMedPubMedCentral

Anderson K, Francis T, Ibanez-Carrasco F, Globerman J. Physician’s Perceptions of Telemedicine in HIV Care Provision: A Cross-Sectional Web-Based Survey. JMIR Public Health Surveill. 2017;3(2): e31.CrossRefPubMedPubMedCentral

10.

Dandachi D, Freytag J, Giordano TP, Dang BN. It is Time to Include Telehealth in Our Measure of Patient Retention in HIV Care. AIDS Behav. 2020;24(9):2463–5.CrossRefPubMedPubMedCentral

11.

Ohl ME, Richardson K, Rodriguez-Barradas MC, Bedimo R, Marconi V, Morano JP, et al. Impact of Availability of Telehealth Programs on Documented HIV Viral Suppression: A Cluster-Randomized Program Evaluation in the Veterans Health Administration. Open Forum Infectious Diseases. 2019;6(6):ofid/ofz206. Available from: https://academic.oup.com/ofid/article/6/6/ofz206/5487764.

12.

Dawson L, Kates J. Delivering HIV Care and Prevention in the COVID Era: A National Survey of Ryan White Providers2020. Available from: https://www.kff.org/report-section/delivering-hiv-care-prevention-in-the-covid-era-a-national-survey-of-ryan-white-providers-issue-brief/.

13.

Division of HIV and STD Programs DoPH, County of Los Angeles. HIV Surveillance Annual Report, 2020.July 30, 2021. Available from: http://publichealth.lacounty.gov/dhsp/Reports.htm.

14.

Saurman E. Improving access: modifying Penchansky and Thomas’s Theory of Access. J Health Serv Res Policy. 2016;21(1):36–9.CrossRefPubMed

15.

Damschroder LJ, Aron DC, Keith RE, Kirsh SR, Alexander JA, Lowery JC. Fostering implementation of health services research findings into practice: a consolidated framework for advancing implementation science. Implement Sci. 2009;4(1):50.CrossRefPubMedPubMedCentral

16.

Braun V, Clarke V. Using thematic analysis in psychology. Qual Res Psychol. 2006;3(2):77–101.CrossRef

17.

Meehan T, Vermeer C, Windsor C. Patients’ perceptions of seclusion: a qualitative investigation. J Adv Nurs. 2000;31(2):370–7.CrossRefPubMed

18.

Taylor G, Ussher J. Making Sense of S&M: A Discourse Analytic Account. Sexualities. 2001;4(3):293–314.CrossRef

19.

Braun V, Gavey N, McPhillips K. The “Fair Deal”? Unpacking Accounts of Reciprocity in Heterosex. Sexualities. 2003;6(2):237–61.CrossRef

20.

Orrange S, Patel A, Mack WJ, Cassetta J. Patient Satisfaction and Trust in Telemedicine During the COVID-19 Pandemic: Retrospective Observational Study. JMIR Hum Factors. 2021;8(2): e28589.CrossRefPubMedPubMedCentral

21.

Mustafa SS, Vadamalai K, Ramsey A. Patient Satisfaction with In-Person, Video, and Telephone Allergy/Immunology Evaluations During the COVID-19 Pandemic. The Journal of Allergy and Clinical Immunology: In Practice. 2021;9(5):1858–63:j.jaip.2021.01.036. Available from: https://www.sciencedirect.com/science/article/pii/S2213219821001641?via%3Dihub.

22.

Dandachi D, Dang BN, Lucari B, Teti M, Giordano TP. Exploring the Attitudes of Patients with HIV About Using Telehealth for HIV Care. AIDS Patient Care STDS. 2020;34(4):166–72.CrossRefPubMed

23.

Lau R, Stevenson F, Ong BN, Dziedzic K, Treweek S, Eldridge S, et al. Achieving change in primary care—causes of the evidence to practice gap: systematic reviews of reviews. Implementation Science. 2015;11(1):s13012-016-0396-4. Available from: https://implementationscience.biomedcentral.com/articles/10.1186/s13012-016-0396-4.

24.

Kadu MK, Stolee P. Facilitators and barriers of implementing the chronic care model in primary care: a systematic review. BMC Fam Pract. 2015;16(1):12.CrossRefPubMedPubMedCentral

25.

Sauers-Ford HS, Hamline MY, Gosdin MM, Kair LR, Weinberg GM, Marcin JP, et al. Acceptability, Usability, and Effectiveness: A Qualitative Study Evaluating a Pediatric Telemedicine Program. Acad Emerg Med. 2019;26(9):1022–33.CrossRefPubMedPubMedCentral

26.

Perkins MB, Jensen PS, Jaccard J, Gollwitzer P, Oettingen G, Pappadopulos E, et al. Applying Theory-Driven Approaches to Understanding and Modifying Clinicians’ Behavior: What Do We Know? Psychiatr Serv. 2007;58(3):342–8.CrossRefPubMed

27.

Uscher-Pines L, Sousa J, Jones M, Whaley C, Perrone C, Mccullough C, et al. Telehealth Use Among Safety-Net Organizations in California During the COVID-19 Pandemic. JAMA. 2021;325(11):1106.CrossRefPubMedPubMedCentral

28.

Uscher-Pines L, Schulson L. Rethinking the Impact of Audio-Only Visits on Health Equity. Health Affairs Forefront [Internet]. 2021. Available from: https://www.healthaffairs.org/do/10.1377/forefront.20211215.549778/full/.

29.

Wood BR, Lan KF, Tao Y, Mose EY, Aas E, Budak JZ, et al. Visit trends and factors associated with telemedicine uptake among persons with HIV during the COVID-19 pandemic. Open Forum Infect Dis. 2021;8(11):ofid/ofab480. Available from: https://academic.oup.com/ofid/article/8/11/ofab480/6374517.

30.

Cranen K, Huis in't Veld R, Ijzerman M, Vollenbroek-Hutten M. Change of patients' perceptions of telemedicine after brief use. Telemed E-Health. 2011;17(7):530–5:tmj.2010.0208. Available from: https://www.liebertpub.com/doi/10.1089/tmj.2010.0208.

31.

Hrountas S, Bier AJ, Green S. A Post-Covid New Normal: Developing Fundamental Changes for Group Medical Practices. Innovations in Care Delivery [Internet]. 2020. Available from: https://catalyst.nejm.org/doi/full/10.1056/CAT.20.0427.

32.

Epstein RM, Street RL. The Values and Value of Patient-Centered Care. Ann Fam Med. 2011;9(2):100–3.CrossRefPubMedPubMedCentral

33.

Mehrotra A, Uscher-Pines L. Informing the Debate about Telemedicine Reimbursement — What Do We Need to Know? N Engl J Med. 2022;387(20):1821–3.CrossRefPubMed

Title: Experiences with telemedicine for HIV care in two federally qualified health centers in Los Angeles: a qualitative study
Authors: Daisy Walker
Corrina Moucheraud
Derrick Butler
Jerome de Vente
Kevin Tangonan
Steven Shoptaw
Judith S. Currier
Jay Gladstein
Risa Hoffman
Publication date: 01-12-2023
Publisher: BioMed Central
Keywords: Care
Human Immunodeficiency Virus
Telemedicine
Published in: BMC Health Services Research / Issue 1/2023
Electronic ISSN: 1472-6963
DOI: https://doi.org/10.1186/s12913-023-09107-1

Keynote webinar | Spotlight on medication adherence

Springer Medicine

Experiences with telemedicine for HIV care in two federally qualified health centers in Los Angeles: a qualitative study

Abstract

Background

Methods

Results

Conclusions

Keynote webinar | Spotlight on medication adherence

Springer Medicine

Abstract

Background

Methods

Results

Conclusions

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