Telehealth during COVID-19: Perspectives on Usability by US Physicians

Abstract

Objective: To understand the usability of telehealth among physicians caring for older adults during the COVID-19 pandemic. Methods: We interviewed US-based physicians specializing in emergency medicine, geriatrics, and primary care who provided care during the COVID-19 pandemic. The interview guide was grounded in the unified theory of acceptance and use of technology (UTAUT). After conducting interviews probing their experiences delivering care using telehealth, we performed framework analysis to reveal major themes in telehealth usability. Results: Forty-eight physicians (15 emergency physicians, 18 geriatricians, 15 primary care physicians) participated in interviews from September 2, 2020 to November 20, 2020. Lack of prior use of telehealth, quick adoption of telehealth, technical deficiencies in platforms, and frequent visits with older adults made using telehealth more difficult. Physicians shared low self-efficacy when using telehealth for diagnosis in certain patient populations, like older patients, new patients, and patients with atypical presentations or non-specific symptoms. By contrast, they had high self-efficacy if they received training, had existing technical proficiency, or were meeting established patients. Key facilitating conditions include easy-to-use telehealth platforms, the inclusion of third parties—like patients’ children or nurses—in virtual visits, and at-home medical devices like blood pressure cuffs or pulse oximeters. Conclusions: While physicians largely found that telehealth platforms were usable to deliver care to patients remotely, there were several technical and training-related barriers that impeded telehealth’s usability at the onset of the pandemic. Simpler telehealth platforms with easy-to-use features, involvement of caregivers, telehealth training, and remote diagnostic devices increased the usability of telehealth.