Staff Perspectives and Acceptance of Telehealth in Scaling a Home-Based Primary Care Program: A Qualitative Study (Preprint)

BACKGROUND Novel and sustainable approaches to scale Home-Based Primary Care (HBPC) programs are needed to meet the medical needs of a growing number of homebound older adults in the US. Telehealth may be a viable option for scaling HBPC programs. OBJECTIVE The purpose of this qualitative study was to gain insight into the perspectives of HBPC staff regarding adopting telehealth technology to scale the program. METHODS We collected qualitative data from HBPC staff (physicians, nurses, nurse practitioners, care managers, social workers, and medical coordinators) at a practice in the New York Metropolitan area through 16 semi-structured interviews and 3 focus groups. Data were analyzed thematically using the template analysis approach with Self-Determination Theory concepts (relatedness, competence, and autonomy) as an analytical lens. RESULTS Four broad themes (work climate, technology impact on staff autonomy, technology impact on competence in providing care, and technology impact on the patient-caregiver-provider relationship) and multiple second-level themes emerged from the analysis. Within the theme of work climate, staff acknowledged the need to scale the program without diminishing effective patient-centered care. Within the theme of technology impact on staff autonomy, participants perceived alerts generated from patients and caregivers using telehealth as a potentially increasing burden and necessitating a rapid response from an already busy staff while increasing ambiguity. Regarding technology impact on competence in providing care, participants noted that it could increase efficiency and enable more informed care provision. Regarding technology impact on the patient-provider relationship, participants noted the opportunity to make caregivers part of the team through telehealth. Staff members, however, were concerned that patients or caregivers might unnecessarily over utilize the technology, and that some visits are more appropriate in-person rather than via telehealth. CONCLUSIONS These findings suggest the importance of taking into account the perspectives of medical professionals regarding telehealth adoption. A proactive approach exploring the benefits and concerns professionals perceive in the adoption of health technology within the HBPC program is likely to facilitate the integration of telehealth innovations. CLINICALTRIAL Not applicable