Pediatrician Perceived Barriers to Telehealth Use

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.