Telemedicine decision-making in primary care during the COVID-19 pandemic: Balancing patient agency and provider expertise

Abstract

ObjectivesThe COVID-19 pandemic precipitated the expansion of telemedicine use worldwide, introducing a new dimension of healthcare decision-making – choosing a visit format – not previously experienced by most patients or providers. To date, the pandemic's impact on decisions about using telemedicine versus in-person visits in primary care has not been fully explored. The purpose of this study was to examine patient and provider accounts of decision-making about the choice between telemedicine and in-person care during the COVID-19 pandemic. MethodsPrimary care providers and patients were recruited from four healthcare systems across three states in the United States. Participants completed semi-structured interviews about their experiences using telemedicine for primary care during the pandemic. Data pertaining to decision-making about telemedicine were examined as a secondary analysis using interpretive description. ResultsTwenty-one providers and 65 patients completed interviews. Patients’ ability to choose their own visit format influenced their level of satisfaction with telemedicine care, while providers expressed concern about leaving visit format entirely up to their patients. Patients and providers generally agreed that telemedicine was well-suited for routine follow-ups, reviewing results, and medication management. However, in cases of urgent health problems, patients and providers differed in their criteria for determining what visit format is most appropriate but agreed that telemedicine could be a useful tool for “quick fixes” and for fast and effective triage. ConclusionsPrimary care patients and providers emphasized the importance of agency during care delivery and shared opportunities for effective triage via telemedicine. Further research should focus on developing tools to support shared healthcare decisions regarding telemedicine use under changing healthcare conditions, particularly for urgent health questions. Public Interest SummaryThe COVID-19 pandemic has increased telemedicine use around the world. This study looked at patient and provider decisions about using telemedicine versus in-person care during the pandemic. We asked 21 primary care providers and 65 patients from four healthcare systems across three U.S. states about their experiences using telemedicine during the pandemic. Patients were more satisfied if they were able to choose whether to have an in-person or video visit, while providers worried that allowing patients to choose the visit format could get in the way of care when patients need physical exams or laboratory testing. Patients and providers gave different reasons for choosing a visit format, but both agreed that telemedicine was useful for “quick fixes” and making decisions together in emergencies. Healthcare systems should create tools to help patients and providers decide when to use telemedicine, especially when managing urgent health issues.