Nephrologist Perspectives on Using Telemedicine During In-Center Hemodialysis: A Qualitative Study.

RATIONALE &

OBJECTIVE

During the coronavirus disease 2019 (COVID-19) pandemic, the US government expanded originating telemedicine sites to include outpatient dialysis units. For the first time, nephrology care providers (nephrologists and affiliated advanced practice providers) across the United States could use telemedicine in lieu of face-to-face visits to deliver care for patients receiving in-center hemodialysis. In this study, we describe perspectives and experiences of nephrologists using telemedicine to deliver in-center hemodialysis care.

STUDY

DESIGN

Qualitative research study.

SETTING &

PARTICIPANTS

Nephrologists in 3 health systems who used telemedicine for in-center hemodialysis during the COVID-19 pandemic.

ANALYTICAL APPROACH: We conducted 16 semistructured telephone interviews. Transcripts were thematically analyzed.

RESULTS

We identified 5 themes and respective subthemes: maintaining safety and quality of care (making up missed appointments, fostering continuity of care, addressing urgent medical issues); maximizing efficiency (reducing nephrologists' travel burden, allowing for flexibility); operational complexities (dependence on facility resources; challenges coordinating with facility staff; modifying visit duration/length); diminished depth of clinical encounters (excess formality, constrained communication, incomplete physical examinations); supporting confidence in telemedicine (complementing in-person care, accounting for patient preferences, requiring reimbursement).

LIMITATIONS: The transferability of the findings outside of an urban academic setting is uncertain.

CONCLUSIONS

Although nephrologists encountered operational (both technical and personal level) challenges such as communication constraints when using telemedicine for in-center hemodialysis care, they reported improvements in aspects of care quality and enhanced efficiency. These findings inform the potential use of a hybrid in-center hemodialysis care delivery model in which telemedicine supplements in-person visits.

PLAIN-LANGUAGE SUMMARY: We describe nephrologists' perspectives and experiences with delivery of care using telemedicine at dialysis facilities during the COVID-19 pandemic. The nephrologists participating in this study suggested telemedicine is beneficial to maintaining patient safety and quality of care and maximizing physicians' efficiency. Nephrologists experienced barriers given operational complexities such as technical and personnel support from dialysis facilities. Clinical encounters were also less personal and more formal. Nevertheless, the experiences of participating nephrologists suggest that a hybrid care model with both in-person and telemedicine visits may help maintain high-quality care while increasing the efficiency of delivering clinical care. These findings inform the potential use of a hybrid in-center hemodialysis care delivery model.