Primary care practices varied in ability to adapt to telemedicine when pandemic began

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When demand for telemedicine visits surged with the arrival of COVID-19, why were some primary care practices better able to meet the demand than others? A new study in Annals of Internal Medicine identifies four broad reasons behind the difference.

The study’s authors surveyed 25 practice leaders, representing 87 primary care practices in Florida and New York, about their practices’ experiences with implementing telemedicine. Questions were guided by three “frameworks,” including health information technology evaluation, access to care, and health information technology life cycle.

After analyzing the responses, the researchers identified four overarching themes. First was that the ease with which a practice adopted telemedicine depended greatly on its prior experience with virtual health. In scheduling visits, for example, experienced practices knew the importance of grouping telehealth visits together because many doctors have difficulty alternating between face-to-face and telehealth visits.

A second theme was the impact of regulatory differences for telehealth among states, especially in areas such as prescribing controlled substances via telemedicine visits and licensing issues. The study quotes one Florida-based respondent who wrote that licensure had been “a moving target throughout the past year,” and that many of his colleagues had gotten licensed in Georgia so they could treat preexisting patients.

“Such differences can be as basic as differing definitions of telehealth, telemedicine, and subsequent coverage laws, with only 15 states covering audio-only visits, whereas all 50 states reimburse for synchronous video visits,” the authors note.

The third theme was unclear triaging rules--which patients could be treated virtually and which required an in-person visit. “Respondents uniformly agreed that not all visit types are suitable for a telemedicine encounter, leaving much of the decision-making power to the discretion of practices,” they said.

The final theme to emerge was the dichotomy between what respondents saw as telehealth’s benefits for patients versus its drawbacks for providers. Many saw telemedicine as particularly well-suited for certain visit types, such as mental health and diabetes management. The downsides included often working beyond normal business hours helping patients with technical issues, having to make judgment calls as to when an in-person visit was required without clear guidelines, and the lack of office support while treating patients virtually.

“The Telemedicine Experiencce in Primary Care Practices in the United States: Insights From Practice Leaders” was published in the May/June 2023 issue of Annals of Family Medicine.