Factors Informing High-Risk Primary Care Patient Choice around Telehealth Use: a Framework.

Area of Science:

• Health Services Research
• Digital Health
• Primary Care Medicine

Background:

• Telehealth's role in post-pandemic primary care is evolving, particularly for high-risk populations.
• Patient preferences for telehealth vary, necessitating an understanding of influencing factors.
• Value-based care models emphasize preventive and chronic disease management, where telehealth may play a role.

Purpose of the Study:

• To explore factors influencing high-risk primary care patients' decisions regarding telehealth, in-office visits, or deferring care.
• To identify patient perspectives on choosing between different primary care modalities.
• To inform strategies for optimizing telehealth utilization in primary care.

Main Methods:

• Qualitative, cross-sectional study using semi-structured telephone interviews.
• Convenience sample of 29 high-risk primary care patients.
• Grounded theory and constant comparison analysis to identify themes.

Main Results:

• Four key themes emerged: perceived utility, underlying costs (time, money, effort, safety), modifiers (clinical situation, availability), and drivers (background, digital environment).
• Patient choices regarding telehealth are influenced by a complex interplay of these factors.
• A novel framework illustrating patient choice in telehealth use was developed.

Conclusions:

• Perceived utility and cost are primary drivers, but modifiers and drivers significantly impact decisions about telehealth use.
• Understanding these nuanced factors is crucial for policymakers, payers, and health systems.
• Strategies can be developed to enhance equitable and high-value telehealth adoption among high-risk individuals.