Delivering Urgent Care Using Telemedicine: Insights from Experienced Clinicians at Academic Medical Centers

Natalie Laub; Anish K Agarwal; Catherine Shi; Arianna Sjamsu; Krisda Chaiyachati

doi:10.1007/s11606-020-06395-9

Delivering Urgent Care Using Telemedicine: Insights from Experienced Clinicians at Academic Medical Centers

J Gen Intern Med. 2022 Mar;37(4):707-713. doi: 10.1007/s11606-020-06395-9. Epub 2021 Dec 17.

Authors

Natalie Laub^{1

2

3}, Anish K Agarwal^{4

5

6}, Catherine Shi^{4

7}, Arianna Sjamsu⁸, Krisda Chaiyachati^{4

5

7}

Affiliations

¹ Division of General Pediatrics, The Children's Hospital of Philadelphia, Philadelphia, PA, USA. laubn@email.chop.edu.
² Center for Pediatric Clinical Effectiveness and Policy Lab, The Children's Hospital of Philadelphia, Philadelphia, PA, USA. laubn@email.chop.edu.
³ Department of Pediatrics, Perelman School of Medicine at the University of Pennsylvania, Philadelphia, PA, USA. laubn@email.chop.edu.
⁴ Penn Medicine Center for Health Care Innovation, Philadelphia, PA, USA.
⁵ Leonard Davis Institute of Health Economics, The University of Pennsylvania, Philadelphia, PA, USA.
⁶ Department of Emergency Medicine, Perelman School of Medicine at the Hospital of the University of Pennsylvania, Philadelphia, PA, USA.
⁷ Department of Medicine, Perelman School of Medicine at the University of Pennsylvania, Philadelphia, PA, USA.
⁸ New York Institute of Technology College of Osteopathic Medicine, Old Westbury, NY, USA.

Abstract

Background: Care delivered using telemedicine has been steadily growing in the USA but represented a small fraction of overall visits before the COVID-19 pandemic as few clinicians had been providing care using telemedicine. Understanding how experienced clinicians have practiced telemedicine can help guide today's exponential adoption of telemedicine.

Objective: The objective of this study was to explore barriers and facilitators to providing effective, high-quality urgent care using telemedicine ("tele-urgent care") from the perspective of clinicians experienced in telemedicine.

Approach: We conducted semi-structured interviews between July 2018 and March 2019 of clinicians who had been providing tele-urgent care services to patients as a part of their routine clinical practice. Themes were identified using content analysis with a constant comparative coding approach.

Key results: Among the 20 clinicians interviewed, the majority were female (90%) and nurse practitioners (65%). We identified four themes related to barriers and facilitators to providing effective, high-quality tele-urgent care. Workplace factors such as a strong information technology (IT) infrastructure, real-time IT support, an electronic health record, and a collegial work environment, often virtual, were necessary standards. Communication and exam techniques from in-person encounters were adapted to tele-urgent care including active listening skills and teaching patients to conduct specific exam maneuvers virtually. The convenience of tele-urgent care should be preserved to support improvements in access to care. Finally, patients and clinicians occasionally had mismatched expectations about what could or would be provided during a tele-urgent care encounter. Managing the added tension that can occur during a telemedicine encounter was important.

Conclusion: As telemedicine becomes an integral part of the care continuum, incorporating and accounting for these key insights when we train and support clinicians will be necessary to provide effective, high-quality care to patients in the future.

Keywords: provider experiences; telemedicine; urgent care.

Publication types

Research Support, Non-U.S. Gov't

MeSH terms

Academic Medical Centers
Ambulatory Care
COVID-19* / epidemiology
Female
Humans
Male
Pandemics
SARS-CoV-2
Telemedicine* / methods