Provider, Staff, and Patient Perspectives on medical Visits Using Clinical Video Telehealth: A Foundation for Educational Initiatives to Improve Medical Care in Telehealth.

Clinical Video Telehealth (CVT) use is increasing and allows geographically separated care; however, this separation may affect participants behaviors. Using semi-structured in-depth interviews, we asked CVT nurse practitioners (NP), staff and patients at a VA Medical Center about perspectives on how CVT effects communication and identified three themes. They remarked on the complexity of scheduling appointments, local barriers to care, and acutely ill patients. NPs discussed how CVT altered sensory collection during the physical exam and differences in building provider-patient relationships. Patients perceptions mirrored these themes. NPs identified how CVT requires different workflow, behaviors, and use of their senses. Patients expressed similar concerns with CVT.

"I'm Not Feeling Like I'm Part of the Conversation" Patients' Perspectives on Communicating in Clinical Video Telehealth Visits.

BACKGROUND: Clinical video telehealth (CVT) offers the opportunity to improve access to healthcare providers in medically underserved areas. However, because CVT encounters are mediated through technology, they may result in unintended consequences related to the patient-provider interaction. METHODS: Twenty-seven patients with type 2 diabetes mellitus enrolled in Veteran Affairs Health Care and at least one previous telehealth visit experience were interviewed regarding their perspectives on facilitators and barriers to communication with their provider during their CVT visit. The semi-structured telephone interviews were approximately 30 min and were audio-recorded and transcribed. We conducted a thematic content analysis of the interview transcripts. Codes from the transcripts were grouped into thematic categories using the constant comparison method and each theme is represented with illustrative quotes. RESULTS: We identified several themes related to patients' perspectives on CVT. In general, patients expressed satisfaction with CVT visits including better access to appointments, shorter travel time, and less time in the waiting room. Yet, patients also identified several challenges and concerns about CVT visits compared with in-person visits, including concerns about errors in their care because of perceived difficulty completing the physical exam, perceptions that providers paid less attention to them, barriers to speaking up and asking questions, and difficulty establishing a provider-patient relationship. Patients reported feeling less involved during the visit, difficulty finding opportunities to speak, and feeling rushed by the provider. CONCLUSIONS: Patients believed that CVT can improve their access to care, but could hinder communication with their provider, and some were concerned about the completeness and accuracy of the physical exam.

A brief pre-visit educational video improved patient engagement after telehealth visits; results from a randomized controlled trial.

Objective: To test an intervention designed to improve patient engagement in telehealth visits by encouraging patients to use active communication behaviors. Methods: US Veterans with type 2 diabetes mellitus receiving primary care using telehealth were randomized 1:1 to receive both a pre-visit educational video and pamphlet (intervention) or pamphlet alone (control) prior to their scheduled telehealth visit. Data were collected before and after the intervention from the medical record and at telephone interviews (questionnaires). Analyses compared the intervention and control groups using bivariate statistics and multiple regression. Results: There were no statistically significant differences in baseline Hemoglobin A1c (HbA1c) between intervention and control groups (P > 0.05). Patient's ratings of physicians' communication and post-visit empathy were higher (P ≤ 0.05) in the intervention group than control group and after adjusting for baseline values the intervention group reported higher scores on post-visit therapeutic alliance with the provider and higher patient engagement, compared with the control group, P = 0.01 and P = 0.04, respectively, but post-visit HbA1c was not statistically different. Conclusions: The educational video was useful as pre-visit preparation for patients prior to a primary care telehealth visit. Innovation: This study showed the efficacy of a pre-visit video to improve patient engagement and therapeutic alliance after telehealth visits.ClinicalTrials.govIdentifier: NCT02522494.

Research without results: inadequate public reporting of clinical trial results.

OBJECTIVE: In order to increase transparency in the medical literature, the Food and Drug Administration (FDA) Modernization Act of 1997 and the FDA Amendment Act of 2007 required registration of all "applicable trials" with required "basic results" reporting. We evaluated the rate of compliance with the FDA mandatory results reporting in www.clinicaltrials.gov. METHODS: All completed registered interventional studies that may be subject to FDA regulation, one year prior to required results reporting (October 2006 to September 2007, n = 1097) and during the two years after required reporting (October 2007 to September 2008 (07-08), n = 2231 and October 2008 to September 2009 (08-09), n = 2923). RESULTS: Downloading all 99,315 records from clinicaltrials.gov, we excluded all non-applicable studies. Results reporting increased from 6.8% (n = 75) prior to mandatory reporting to 19.1% (n = 427, p<.01) in 07-08 and 10.8% (n = 316, p<.01) in 08-09. The odds ratio for results reporting using the 06-07 time period as the reference was 3.31 (95% CI 2.54-4.32) for 07-08 and 1.74 (1.33-2.28) for 08-09. Of the 818 trials with results in clinicaltrials.gov, the rate of published articles found decreased from 60% (n = 45) in the year prior to required reporting to 33% (n = 140, p<.001) for 07-08 and 20% (n = 63, p<.001) for 08-09 time period. CONCLUSION: The majority of studies registered in clinicaltrials.gov are not required to report data. Of studies that may be required to report data, compliance with data reporting has improved. The clinicaltrials.gov website is not yet a comprehensive resource for study results.