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      • Record: found
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      Veteran, Primary Care Provider, and Specialist Satisfaction With Electronic Consultation

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          Abstract

          Background

          Access to specialty care is challenging for veterans in rural locations. To address this challenge, in December 2009, the Veterans Affairs (VA) Pittsburgh Healthcare System (VAPHS) implemented an electronic consultation (e-consult) program to provide primary care providers (PCPs) and patients with enhanced specialty care access.

          Objective

          The aim of this quality improvement (QI) project evaluation was to: (1) assess satisfaction with the e-consult process, and (2) identify perceived facilitators and barriers to using the e-consult program.

          Methods

          We conducted semistructured telephone interviews with veteran patients (N=15), Community Based Outpatient Clinic (CBOC) PCPs (N=15), and VA Pittsburgh specialty physicians (N=4) who used the e-consult program between December 2009 to August 2010. Participants answered questions regarding satisfaction in eight domains and identified factors contributing to their responses.

          Results

          Most participants were white (patients=87%; PCPs=80%; specialists=75%) and male (patients=93%; PCPs=67%; specialists=75%). On average, patients had one e-consult (SD 0), PCPs initiated 6 e-consults (SD 6), and VAPHS specialists performed 17 e-consults (SD 11). Patients, PCPs, and specialty physicians were satisfied with e-consults median (range) of 5.0 (4-5) on 1-5 Likert-scale, 4.0 (3-5), and 3.5 (3-5) respectively. The most common reason why patients and specialists reported increased overall satisfaction with e-consults was improved communication, whereas improved timeliness of care was the most common reason for PCPs. Communication was the most reported perceived barrier and facilitator to e-consult use.

          Conclusions

          Veterans and VA health care providers were satisfied with the e-consult process. Our findings suggest that while the reasons for satisfaction with e-consult differ somewhat for patients and physicians, e-consult may be a useful tool to improve VA health care system access for rural patients.

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          Most cited references21

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          Basics of Qualitative Research : Techniques and Procedures for Developing Grounded Theory

          Anselm Strauss, Juliet M. Corbin (1998)
          The Second Edition of this best-selling textbook continues to offer immensely practical advice and technical expertise that will aid researchers in analyzing and interpreting their collected data, and ultimately build theory from it. The authors provide a step-by-step guide to the research act. Full of definitions and illustrative examples, the book presents criteria for evaluating a study as well as responses to common questions posed by students of qualitative research.
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            Distance is relative: unpacking a principal barrier in rural healthcare.

            Colin Buzza, Stacy Wittrock, Heather Reisinger … (2011)
            Distance to healthcare services is a known barrier to access. However, the degree to which distance is a barrier is not well described. Distance may impact different patients in different ways and be mediated by the context of medical need. Identify factors related to distance that impede access to care for rural veterans. Mixed-methods approach including surveys, in-depth interviews, and focus groups at 15 Veterans Health Administration (VHA) primary care clinics in 8 Midwestern states. Survey data were compiled and interviews transcribed and coded for thematic content. Surveys were completed by 96 patients and 88 providers/staff. In-depth interviews were completed by 42 patients and 64 providers/staff. A total of 7 focus groups were convened consisting of providers and staff. Distance was identified by patients, providers, and staff as the most important barrier for rural veterans seeking healthcare. In-depth interviews revealed specific examples of barriers to care such as long travel for common diagnostic services, routine specialty care, and emergency services. Patient factors compounding the impact of these barriers were health status, functional impairment, travel cost, and work or family obligations. Providers and staff reported challenges to healthcare delivery due to distance. Distance as a barrier to healthcare was not uniformly defined. Rather, its importance was relative to the health status and resources of patients, complexity of service provided, and urgency of service needed. Improved transportation, flexible fee-based services, more structured communication mechanisms, and integration with community resources will improve access to care and overall health status for rural veterans.
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              Limitations of patient satisfaction studies in telehealthcare: a systematic review of the literature.

              T L Williams, Preston T. J. A. Williams, Muneer A. Esmail (2000)
              The objective of this study is to provide a systematic review of studies on patient satisfaction with telemedicine. The review included empirical studies that investigated patient satisfaction with that telemedicine service. The search strategy involved matching at least one of 11 'telemedicine' terms with one of 5 'satisfaction' terms. The following databases were searched: Telemedicine Information Exchange (TIE) database, MEDLINE, Science Citation Index (SCI), Social Science Citation Index (SSCI), Psycinfo, and Citation Index of Nursing and Allied Health (CINAHL). A highly structured instrument was used for data extraction. The review included 93 studies. Telepsychiatry represents the largest portion of these studies (25%), followed by multispecialty care (14%), nursing (11%), and dermatology (8%). Real-time videoconferencing was used in 88% of these studies. Only 19 (20%) included an independent control group, including 9 (10%) randomized control trial (RCT) studies. One third of studies were based on samples of less than 20 patients, and only 21% had samples of over 100 patients. Aspects of patient satisfaction most commonly assessed were: professional-patient interaction, the patient's feeling about the consultation, and technical aspects of the consultation. Only 33% of the studies included a measure of preference between telemedicine and face-to-face consultation. Almost half the studies measured only 1 or 2 dimensions of satisfaction. Reported levels of satisfaction with telemedicine are consistently greater than 80%, and frequently reported at 100%. Progression of telemedicine services from "trial" status to routine health service must be supported by improved research into patients' satisfaction with telemedicine. Further investigation of factors that influence patient acceptance of telemedicine is indicated.
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                Author and article information

                Contributors
                Keri L Rodriguez:
                VA Pittsburgh Healthcare SystemCenter for Health Equity Research and PromotionBuilding 30University Drive C (151C)Pittsburgh, PA, 15240-1001United States1 412 360 22371 412 360 2285keri.rodriguez@va.gov
                ORCID: http://orcid.org/0000-0002-1477-3659
                Journal
                Journal ID (nlm-ta): JMIR Med Inform
                Journal ID (iso-abbrev): JMIR Med Inform
                Journal ID (publisher-id): JMI
                Title: JMIR Medical Informatics
                Publisher: Gunther Eysenbach (JMIR Publications Inc., Toronto, Canada )
                ISSN (Electronic): 2291-9694
                Publication date Collection: Jan-Mar 2015
                Publication date (Electronic): 14 January 2015
                Volume: 3
                Issue: 1
                Electronic Location Identifier: e5
                Affiliations
                [1] 1VA Pittsburgh Healthcare System Center for Health Equity Research and Promotion Pittsburgh, PAUnited States
                [2] 2University of Pittsburgh School of Medicine Division of General Internal Medicine, Department of Medicine Pittsburgh, PAUnited States
                [3] 3VA Pittsburgh Healthcare System Veterans Engineering Resource Center Pittsburgh, PAUnited States
                [4] 4Chatham University Departments of Psychology and Social Work/Criminology Pittsburgh, PAUnited States
                [5] 5VA Pittsburgh Healthcare System Facility Management Service Pittsburgh, PAUnited States
                [6] 6University of Pittsburgh Department of Psychiatry Pittsburgh, PAUnited States
                [7] 7University of Pittsburgh Clinical and Translational Science Institute Pittsburgh, PAUnited States
                [8] 8Veterans Integrated Service Network 4 (VISN 4) Healthcare Network Pittsburgh, PAUnited States
                Author notes
                Corresponding Author: Keri L Rodriguez keri.rodriguez@ 123456va.gov
                Author information
                http://orcid.org/0000-0002-1477-3659
                http://orcid.org/0000-0002-5044-2814
                http://orcid.org/0000-0003-3171-4850
                http://orcid.org/0000-0002-0509-7214
                http://orcid.org/0000-0001-8541-9449
                http://orcid.org/0000-0002-1752-9811
                http://orcid.org/0000-0003-3470-9846
                http://orcid.org/0000-0003-2718-7138
                Article
                Publisher ID: v3i1e5
                DOI: 10.2196/medinform.3725
                PMC ID: 4319072
                PubMed ID: 25589233
                SO-VID: 6738bc33-bd14-4551-adf7-e47e9c8f5486
                Copyright © ©Keri L Rodriguez, Kelly H Burkitt, Nichole K Bayliss, Jennifer E Skoko, Galen E Switzer, Susan L Zickmund, Michael J Fine, David S Macpherson. Originally published in JMIR Medical Informatics (http://medinform.jmir.org), 14.01.2015.
                License:

                This is an open-access article distributed under the terms of the Creative Commons Attribution License ( http://creativecommons.org/licenses/by/2.0/), which permits unrestricted use, distribution, and reproduction in any medium, provided the original work, first published in JMIR Medical Informatics, is properly cited. The complete bibliographic information, a link to the original publication on http://medinform.jmir.org/, as well as this copyright and license information must be included.

                History
                Date received : 23 July 2014
                Date revision requested : 07 October 2014
                Date revision received : 05 November 2014
                Date accepted : 23 November 2014
                Categories
                Subject: Original Paper
                Subject: Original Paper

                Keywords: access,rural health,referral and consultation,patient satisfaction,veterans
                Data availability:
                Keywords: access, rural health, referral and consultation, patient satisfaction, veterans

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