Clinician Decision-Making Around Offering Home Video Telehealth Visits: Qualitative Study

Area of Science:

• Health Services Research
• Digital Health
• Telemedicine

Background:

• The COVID-19 pandemic accelerated the adoption of in-home video telehealth, particularly within the Veterans Affairs (VA) healthcare system.
• Disparities in telehealth use based on patient age and rurality have created a persistent digital divide.
• Clinician perceptions of patient age and technical skills as barriers may influence the offering of video visits, especially to older adults.

Purpose of the Study:

• To investigate the decision-making processes of interprofessional clinicians regarding the offer of in-home video telehealth.
• To identify organizational, personal, and attitudinal factors influencing clinicians' decisions to offer video visits.

Main Methods:

• A qualitative study involving semistructured interviews with 16 interprofessional clinicians across 11 VA hospitals.
• Participants had experience with in-home video telehealth within the VA system.
• Directed content analysis with a rapid analytic approach was employed.

Main Results:

• Clinician decisions are multifaceted, influenced by clinician factors (experience, perceived benefits), appointment characteristics (clinical goal), patient factors (age, willingness), social context (caregiver support), geography (internet access, distance), and health system factors (technical support, remote work capability).
• Facilitators for in-home video telehealth access include clinician familiarity with technology, patient technical skill improvement strategies, caregiver support, and robust infrastructure (device availability, broadband reliability, clear protocols).

Conclusions:

• Clinician competency in telehealth, patient/caregiver digital readiness, and supportive technological infrastructure are crucial for equitable in-home video care.
• Enhanced guidance for specific clinical services and awareness of potential biases are needed for consistent and accessible telehealth delivery, particularly for older adults and medically complex patients.