Robert Graham Center:Family Physician Characteristics, Attitudes, and Beliefs Regarding

Implementing Telehealth Services

Megan Coffman, MS

November 7, 2015

Robert Graham Center The Robert Graham Center aims to improve individual and population healthcare delivery

through the generation or synthesis of evidence that brings a family medicine and primary care perspective to health policy

deliberations from the local to international levels.

Robert Graham Center – Who We Are

Research Topics

Mapping Tools

Some Recent Work

The Project • The State of Telehealth in Primary Care

– Literature Review– Expert Panel– Survey of Family Physicians

Funded by Anthem,Inc.

What is Telehealth?• Telehealth: the exchange of medical

information from one location to another via electronic communications

Why Telehealth? • Telehealth is shown to:

– expand patients access to care, – increase continuity of care, – improve coordination of care – reduce healthcare costs, and – improve health outcomes

• Some indication of low usage in primary care

Highlights from the Literature Review and Expert Panel

• There is very little research on telehealth in primary care

• The literature indicates that patients appreciate the convenience of access to telehealth services, and are satisfied with the care they receive remotely

• Patients see saving time and travel as benefits of telehealth compared to in-person care

Survey Objectives• Measure penetration of telehealth into primary care

setting– Hypothesis: low penetration

• Characterize Family Physicians (FPs) who use telehealth– Hypothesis: higher use in rural setting, larger practices,

and younger physicians• Investigate Attitudes/Beliefs of FPs regarding

telehealth– Hypothesis: Users have more favorable attitudes/beliefs

Who did we ask? • Survey of 5,000 randomly selected FPs

– AMA Physician Masterfile (2014) linked to AAFP member list

– FPs in direct patient care– Oversample rural 2:1

The Survey

Survey Questions• All Respondents

– Provider Characteristics– Practice Characteristics– Attitudes About Telehealth (Likert Scales)

• Users/Non-Users Separate– Use of Telehealth (users only)– Beliefs About Telehealth (similar but distinct)

(Likert Scales)

Telehealth DefinedTelehealth services defined as:

1. Primary care services: a physician providing care for a patient via live interactive video and/or

2. Primary care and specialist referral services: a primary care provider consulting with a specialist via live interactive video and/or

3. Store and Forward: sharing electronic patient data between a primary care provider and specialist across locations

Survey Data• 1,557 survey responses were analyzed

– 1,630 surveys were returned (31% response rate)– 53 surveys were returned but not used

• Non-unique ID• Respondent indicated they did NOT engage in direct

patient care or did not answer this question

• Sample weights were used to ensure the estimates computed were representative of family physicians across the United States

Results: Demographics• 15% had used telehealth services in the last 12

months (85% had NOT) (N=225)• Telehealth users were more likely to

– rural setting (26% versus 12%, p<0.01)– use an EHR (97% vs. 92%, p<0.01)– work with six+ FPs (40% vs. 29%, p<0.01)

• Telehealth users were less likely to:– work in a practice that is privately owned (22% versus

39%, p<0.01) – Provide general primary care (76% vs. 86%, p<0.01)

Prevalence of Telehealth Use by Type of Service Used

Source: Robert Graham Center Analysis of 2014 AAFP Telehealth Survey of Family Physicians, N=225

Administrative Purpose

Other

Emergency Care

Second Opinion

Follow-Up

Chronic Disease Management

Diagnoses or Treatment

6%

13%

16%

20%

21%

26%

55%

Percent of Telehealth Users Who Indicated Each Reason for Use

Source: Robert Graham Center Analysis of 2014 AAFP Telehealth Survey of Family Physicians, N=225

Results: Attitudes and Beliefs

• Telehealth users and non-users agree:– Telehealth improves access to care for my

patients. (89% users vs. 77% non-users, p<0.01)

– Telehealth improves the continuity of care for my patients. (75% vs. 68%, p<0.01)

– Patients prefer to see their doctor in person. (83% vs. 94%, p<0.01)

Results: Barriers• Which of the following are barriers to using

telehealth in your practice? – Cost of equipment (35% users vs. 47% non-

users)– Lack of training about how to use telehealth in a

family medicine practice (40% vs. 55%)– Reimbursement by insurers (46% vs. 54%)– Potential liability issues associated with the use

of telehealth (26% vs. 41%)

Barriers to Using Telehealth

Limitations• Survey Biases: Self-reported response &

recall (esp. in terms of frequency of use)• Response rate of 31% and small sample

of telehealth users• Close ended questions – with opened

“other” options

Discussion• FPs see telehealth as enhancing access

to care and improving continuity of care• Barriers impeding use are policy amenable

– offer new opportunities for training – address implementation costs– increase awareness of current reimbursement– develop new ways to reimburse

Survey Study Conclusion• FPs views of telehealth are generally

positive• Barriers to larger adoption remain• Small but significant number of family

physicians who are providing telehealth services for patients

What’s Next? • A survey of Blue Cross, Blue Shield

patients in California and Ohio measuring patient satisfaction

• A survey of Family Medicine Residency Directors

Thank You and More • To learn more about the Robert Graham

Center’s work, visit our website: http://www.graham-center.org/rgc/home.html

• If you have specific questions on the telehealth project, email me at:

mcoffman@aafp.org