Opportunities to Enhance the Implementation of Veterans Affairs Video-Based Care: Qualitative Perspectives of Providers from Diverse Specialties

• Published in: Journal of medical Internet research 2023-04, Vol.25 (3), p.e43314-e43314
• Main Authors: Slightam, Cindie, Wray, Charlie, Tisdale, Rebecca L, Zulman, Donna M, Gray, Caroline
• Format: Article
• Language: English
• Subjects: Cardiology; Clinical skills; Clinics; COVID-19; Delivery of Health Care; Education; Educational materials; Epidemics; Female; Health care; Humans; Implementation; Individual differences; Internet; Interviews; Leadership; Male; Middle Aged; Nurse practitioners; Organizational support; Original Paper; Palliative care; Palliative treatment; Pandemics; Primary care; Primary nursing; Qualitative Research; R&D; Recruitment; Repetition; Research & development; Skills; Spinal cord; Spinal cord injuries; Teams; Telemedicine; United States; United States Department of Veterans Affairs; Uptake; Value; Veterans
• ISSN: 1438-8871; 1439-4456; 1438-8871
• DOI: 10.2196/43314

Increasing the adoption of digital care tools, including video visits, is a long-term goal for the US Department of Veterans Affairs (VA). While previous work has highlighted patient-specific barriers to the use of video visits, few have examined how clinicians view such barriers and how they have overcome them during the rapid uptake of web-based care. This study sought input from providers, given their role as critical participants in video visit implementation, to qualitatively describe successful strategies providers used to adapt their practices to a web-based care setting. We conducted interviews with 28 VA providers (physicians and nurse practitioners) from 4 specialties that represent diverse clinical services: primary care (n=11), cardiology (n=7), palliative care (n=5), and spinal cord injury (n=5). All interviews were audio recorded and transcribed, and transcripts were reviewed and coded according to an iteratively created codebook. To identify themes, codes were grouped together into categories, and participant comments were reviewed for repetition and emphasis on specific points. Finally, themes were mapped to Expert Recommendations for Implementing Change (ERIC) strategies to identify evidence-based opportunities to support video visit uptake in the VA. Interviewees were mostly female (57%, 16/28), with an average age of 49 years and with 2-20 years of experience working in the VA across 16 unique VA facilities. Most providers (82%, 23/28) worked in urban facilities. Many interviewees (78%, 22/28) had some experience with video visits prior to the COVID-19 pandemic, though a majority (61%, 17/28) had conducted fewer than 50 video visits in the quarter prior to recruitment. We identified four primary themes related to how providers adapt their practices to a web-based care setting: (1) peer-based learning and support improved providers' perceived value of and confidence in video visits, (2) providers developed new and refined existing communication and clinical skills to optimize video visits, (3) providers saw opportunities to revisit and refine team roles to optimize the value of video visits for their care teams, and (4) implementing and sustaining web-based care requires institutional and organizational support. We identified several ERIC implementation strategies to support the use of video visits across the individual-, clinic-, and system-levels that correspond to these themes: (1) individual-level strategies include the development of