William L. Cull1, Amanda N. Fisher1, Joshua Alexander2.
1Research, AAP, Elk Grove Village, IL; 2Pediatrics and Physical Medicine & Rehabilitation, University of North Carolina, Chapel Hill, NC.
Presented at the 2017 Pediatric Academic Societies Annual Meeting.
Background: The AAP, in its 2015 policy statement on telehealth, suggested that telehealth could increase access to high-quality pediatric care and that pediatricians should work to reduce barriers to providing telehealth to their patients.
Objective: Establish the percentage of pediatricians using telehealth, identify the most common perceived barriers to telehealth, and evaluate their association with pediatrician and pediatric practice characteristics.
Methods: A 2015-16, random sample survey of AAP U.S. members providing direct patient care, (response rate = 50%, n = 786) collected information on their use of telehealth and on 12 barriers that were grouped into 3 categories (financial, technical, quality). Cronbach's alpha was used to assess reliability within each category, and category summary scores were computed ((0 points for no barrier, 1 point for minor barrier, and 2 points for major barrier)/8 points possible) and compared using repeated-measure ANOVA. Mulitivariable linear regression identified associations of the summary scores with various pediatrician and practice characteristics including: age, gender, primary care practice type, practice ownership, practice location, and work setting.
Results: Fifteen percent of pediatricians reported that they had used or had referred a patient for telehealth in the past year. The most commonly reported barriers to telehealth adoption were financial followed by technical (p < .001), followed by quality (p < .001) concerns (Table). Pediatricians who practiced in suburban areas (B = .55, 95% CI = .12 to .97) and who were practice owners were more likely (B = .70, 95% CI = .21 to 1.20) and pediatricians working in hospitals or medical schools were less likely (B = -.56, 95% CI = -1.1 to -.03) to report financial barriers. Among those who had not used telehealth, 54% reported that they would use it if they were paid for the visits.
Conclusion: Currently, 15% of pediatricians report using telehealth technologies to provide patient care, and the majority of respondents report that financial concerns are a major barrier to incorporating telehealth into their practice. Many pediatricians also report that technical barriers are important, while fewer concerns exist related to the quality of telehealth care.
Table. Pediatrician Reported Barriers to Incorporating Telehealth
|||% Reporting Major Barrier|
|FINANCIAL (Summary Score = .57; Alpha = .84)|| |
|Potential liability issues||63|
|Inability to bill for services||60|
|Insufficient payment for services||59|
|Cost to purchase and maintain equipment||53|
|TECHNICAL (Summary Score = .38; Alpha = .80)|| |
|Lack of vendor information||51|
|Lack of information on subspecialist capability||45|
|Lack of troubleshooting support||34|
|Insufficient electronic infrastructure in area||23|
|QUALITY (Summary Score = .32; Alpha = .72)|| |
|Lack of training||37|
|Lack of confidence in diagnoses||36|
|Lack of usefulness||36|
|Patient reluctance to participate||22|