How can equitable video visit access be delivered in primary care? A qualitative study among rural primary care teams and patients

Abstract

<jats:sec><jats:title>Objective</jats:title><jats:p>The COVID-19 pandemic sparked exponential growth in video visit use in primary care. The rapid shift to virtual from in-person care exacerbated digital access disparities across racial groups and rural populations. Moving forward, it is critical to understand when and how to incorporate video visits equitably into primary care. We sought to develop a novel clinical algorithm to guide primary care clinics on how and when to employ video visits as part of care delivery.</jats:p></jats:sec><jats:sec><jats:title>Design</jats:title><jats:p>Qualitative data collection: one team member conducted all patient semistructured interviews and led all focus groups with four other team members taking notes during groups.</jats:p></jats:sec><jats:sec><jats:title>Setting</jats:title><jats:p>3 rural primary care clinics in the USA.</jats:p></jats:sec><jats:sec><jats:title>Participants</jats:title><jats:p>24 black veterans living in rural areas and three primary care teams caring for black veterans living in rural areas.</jats:p></jats:sec><jats:sec><jats:title>Primary and secondary outcome measures</jats:title><jats:p>Findings from semistructured interviews with patients and focus groups with primary care teams.</jats:p></jats:sec><jats:sec><jats:title>Results</jats:title><jats:p>Key issues around appropriate use of video visits for clinical teams included having adequate technical support, encouraging engagement during video visits and using video visits for appropriate clinical situations. Patients reported challenges with broadband access, inadequate equipment, concerns about the quality of video care, the importance of visit modality choice, and preferences for in-person care experience over virtual care. We developed an algorithm that requires input from both patients and their care team to assess fit for each clinical encounter.</jats:p></jats:sec><jats:sec><jats:title>Conclusions</jats:title><jats:p>Informed matching of patients and clinical situations to the right visit modality, along with individual patient technology support could reduce virtual access disparities.</jats:p></jats:sec>

Department

Description

Provenance

Citation

Published Version (Please cite this version)

10.1136/bmjopen-2022-062261

Publication Info

Goldstein, Karen M, Kathleen R Perry, Allison Lewinski, Conor Walsh, Megan E Shepherd-Banigan, Hayden B Bosworth, Hollis Weidenbacher, Dan V Blalock, et al. (2022). How can equitable video visit access be delivered in primary care? A qualitative study among rural primary care teams and patients. BMJ Open, 12(8). pp. e062261–e062261. 10.1136/bmjopen-2022-062261 Retrieved from https://hdl.handle.net/10161/29378.

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Scholars@Duke

Goldstein

Karen M. Goldstein

Associate Professor of Medicine

Dr. Goldstein's research interests include women's health, cardiovascular risk reduction, evidence synthesis methodology and peer support.

Walsh

Conor Walsh

Medical Instructor in the Department of Medicine
Shepherd-Banigan

Megan E Shepherd-Banigan

Assistant Professor in Population Health Sciences

Dr. Megan Shepherd-Banigan designs research studies to improve the health, emotional well-being, and social functioning of adults with mental and physical disabilities. Her methods combine empirical approaches that address methodologically challenging research questions in health systems and policy research. Dr. Shepherd-Banigan uses large survey and administrative datasets to evaluate the impact of policies that support family members to care for adults with disabilities.  

Dr. Shepherd-Banigan won a VA Career Development Award from 2019-2024 and is studying ways to strengthen family support for veterans under-going traumatic stress treatment. She also leads a project that surveys family caregivers of Vietnam-era veterans who might be eligible for expanded support services under the VA Mission Act to evaluate program impacts. As co-investigator on an NIA-funded CARE IDEAS study (Terri Wetle, PI) , she is investigating end-of-life-care planning and well-being among dementia care dyads.  Finally, Dr. Shepherd-Banigan is leading a project in partnership with the Rosalynn Carter Institute for Caregivers to identify creative empirically-based approaches to support family caregivers. 



Bosworth

Hayden Barry Bosworth

Professor in Population Health Sciences

Dr. Bosworth is a health services researcher and Deputy Director of the Center of Innovation to Accelerate Discovery and Practice Transformation (ADAPT)  at the Durham VA Medical Center. He is also Vice Chair of Education and Professor of Population Health Sciences. He is also a Professor of Medicine, Psychiatry, and Nursing at Duke University Medical Center and Adjunct Professor in Health Policy and Administration at the School of Public Health at the University of North Carolina at Chapel Hill. His research interests comprise three overarching areas of research: 1) clinical research that provides knowledge for improving patients’ treatment adherence and self-management in chronic care; 2) translation research to improve access to quality of care; and 3) eliminate health care disparities. 

Dr. Bosworth is the recipient of an American Heart Association established investigator award, the 2013 VA Undersecretary Award for Outstanding Achievement in Health Services Research (The annual award is the highest honor for VA health services researchers), and a VA Senior Career Scientist Award. In terms of self-management, Dr. Bosworth has expertise developing interventions to improve health behaviors related to hypertension, coronary artery disease, and depression, and has been developing and implementing tailored patient interventions to reduce the burden of other chronic diseases. These trials focus on motivating individuals to initiate health behaviors and sustaining them long term and use members of the healthcare team, particularly pharmacists and nurses. He has been the Principal Investigator of over 30 trials resulting in over 400 peer reviewed publications and four books. This work has been or is being implemented in multiple arenas including Medicaid of North Carolina, private payers, The United Kingdom National Health System Direct, Kaiser Health care system, and the Veterans Affairs.

Areas of Expertise: Health Behavior, Health Services Research, Implementation Science, Health Measurement, and Health Policy

Blalock

Daniel Blalock

Associate Consulting Professor in the Department of Psychiatry and Behavioral Sciences

I am a behavioral health researcher with a background in Clinical Psychology and Experimental Psychology.  My research interests include broad processes of behavior change and self-regulation as well as psychometric measurement and research methods/statistics.  My specific research endeavors include 1) the measurement and behavior change applicability of constructs related to self-control, 2) measurement and interventions to improve self-regulatory health behaviors including medication adherence and substance use, and 3) measure development and psychometrics as related to self-reported and patient-reported outcomes.


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