Preference for Telehealth Sustained Over Three Months at an Outpatient Center for Integrative Medicine

Michael T M Finn; Hannah R Brown; Emily R Friedman; A Grace Kelly; Kathryn Hansen

doi:10.1177/2164956121997361

Preference for Telehealth Sustained Over Three Months at an Outpatient Center for Integrative Medicine

Glob Adv Health Med. 2021 Feb 21:10:2164956121997361. doi: 10.1177/2164956121997361. eCollection 2021.

Authors

Michael T M Finn^{1

2}, Hannah R Brown^{1

3}, Emily R Friedman^{1

3}, A Grace Kelly¹, Kathryn Hansen¹

Affiliations

¹ Osher Center for Integrative Medicine, Vanderbilt University Medical Center, Nashville, Tennessee.
² Adult Congenital Heart Disease Program, Helen DeVos Children's Hospital, Grand Rapids, Michigan.
³ Vanderbilt University School of Nursing, Nashville, Tennessee.

Abstract

Background: Integrative medicine is a key framework for the treatment of chronic medical conditions, particularly chronic pain conditions. The COVID-19 pandemic prompted rapid implementation of telehealth services.

Objective: We present outcomes of a complete and rapid transition to telehealth visits at an outpatient integrative medicine center in the Southeastern United States.

Method: Patients and administrative staff took surveys comparing telehealth to in-person visits within four weeks of our clinic's transition to telehealth and three months later. Beginning four weeks after the clinic's telehealth conversion in March 2020, patients who had a telehealth visit at the center completed a survey about their telehealth experience and another survey three months later.

Results: Patient quality judgements significantly favored telehealth at baseline, B = .77 [0.29 - 1.25], SE = .25, t(712) = 3.15, p = .002, and increased at three months, B = .27 [-0.03 - 0.57], SE = .15, t(712) = 1.76, p = .079. Telehealth technology usability and distance from the center predicted patient ratings of telehealth favorability. Providers favored in-person visits more than patients, B = -1.00 [-1.56 - -0.44], SE = .29, t(799) = -3.48, p < .001, though did not favor either in-person or telehealth more than the other. Patient discrete choice between telehealth and in-person visits was split at baseline (in-person: n = 86 [54%]; telehealth: n = 73 [46%]), but favored telehealth at three months (in-person: n = 17 [40%]; telehealth: n = 26 [60%]). Overall, discrete choice favored telehealth at follow-up across providers and patients, OR = 2.69 [.1.18 - 6.14], z = 2.36, p = .018. Major qualitative themes highlight telehealth as acceptable and convenient, with some challenges including technological issues. Some felt a loss of interpersonal connection during telehealth visits, while others felt the opposite.

Conclusion: We report converging mixed-method data on the successful and sustained implementation of telehealth with associated policy and clinical implications during and beyond the COVID-19 pandemic.

Keywords: health care; implementation and dissemination; integrative medicine; qualitative; telemedicine.