Care Redesign to Support Telemedicine Implementation During the COVID-19 Pandemic: Federally Qualified Health Center Personnel Experiences

Jennifer L Frehn; Brooke E Starn; Hector P Rodriguez; Denise D Payán

doi:10.3122/jabfm.2022.220370R2

Care Redesign to Support Telemedicine Implementation During the COVID-19 Pandemic: Federally Qualified Health Center Personnel Experiences

J Am Board Fam Med. 2023 Oct 11;36(5):712-722. doi: 10.3122/jabfm.2022.220370R2. Epub 2023 Aug 30.

Authors

Jennifer L Frehn¹, Brooke E Starn², Hector P Rodriguez², Denise D Payán²

Affiliations

¹ From the Department of Health Policy and Management, Fielding School of Public Health, University of California, Los Angeles (JLF); Department of Public Health, School of Social Sciences, Humanities and Arts, University of California, Merced (JLF, DDP); Department of Public Health Sciences, School of Medicine, University of California, Davis (BES); Division of Health Policy and Management, School of Public Health, University of California, Berkeley (HPR); Department of Health, Society and Behavior, Public Health Program, University of California, Irvine (DDP). jfrehn@ucla.edu.
² From the Department of Health Policy and Management, Fielding School of Public Health, University of California, Los Angeles (JLF); Department of Public Health, School of Social Sciences, Humanities and Arts, University of California, Merced (JLF, DDP); Department of Public Health Sciences, School of Medicine, University of California, Davis (BES); Division of Health Policy and Management, School of Public Health, University of California, Berkeley (HPR); Department of Health, Society and Behavior, Public Health Program, University of California, Irvine (DDP).

PMID: 37648403
DOI: 10.3122/jabfm.2022.220370R2

Abstract

Background: Federally qualified health centers (FQHCs) rapidly adopted and implemented telemedicine during the COVID-19 pandemic. This study analyzes FQHC personnel accounts of care redesign strategies to support telemedicine implementation in 2020 and 2021, and identifies improvement opportunities.

Methods: We conducted semistructured, in-depth interviews with clinic personnel (n = 15) at 2 FQHCs in Northern California (December 2020-April 2021) to examine telemedicine adoption and use of audio-video and audio-only/phone telemedicine encounters.

Results: FQHC clinicians and staff reported that telemedicine implementation increased access to care and reduced appointment no-show rates. However, a reported reduced ability to develop and foster interpersonal connections negatively impacted clinician-patient relationships. Care redesign strategies included systems to triage appointment types (in-person versus virtual), work-arounds to screen for and address social and nonmedical needs, and new protocols to navigate privacy needs for first time telemedicine users. In addition, increasing remote monitoring capabilities was deemed an important priority for improving telemedicine use for marginalized populations.

Conclusions: Telemedicine implementation in FQHCs involved care redesign to optimize virtual interactions and care processes. Guidelines and evidence-based practices are needed to improve telemedicine use in FQHCs, including strategies to support interpersonal connections; approaches to virtually screen for and address social needs; and protocols to further mitigate privacy issues. Future research is needed to identify when telemedicine can optimally supplement in-person care to improve patient outcomes and clinic efficiency, particularly in safety net settings.

Keywords: COVID-19; Community Health Centers; Health Services Accessibility; Implementation Science; Pandemics; Primary Health Care; Qualitative Research; Quality Improvement; Safety-Net Clinics; Telehealth.

MeSH terms

Ambulatory Care Facilities
COVID-19* / epidemiology
Health Personnel
Humans
Pandemics
Telemedicine* / methods

Grants and funding

T32 HS000046/HS/AHRQ HHS/United States