Virtual visits can resolve many patient concerns effectively, with some variation in PCP comfort using them for specific conditions | “For a family doctor visit, a lot of things you don’t have to see face to face. Some of the things, like minor things, or skin things, they can have a picture, show me, or send me a video clip, then I can make a suggestion that I would if they were there” “I think what it’s good for are for your own patients that are needing refills or [have] chronic conditions”
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| “There is a huge scope for doing mental health visits online because, especially if I did them by camera and stuff, there is nothing I do in a mental health visit that can’t be done online” “And mental health I find that I prefer to have an in-person appointment” “I think there are certain places where it [virtual visits] would work, and maybe palliative would be one of them”
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| “Complex patients, I believe they should have access to this virtual care because in between their regular checkups they might have a quick question about something and that might save them a visit to the office” “I have a lot of [patients who have diabetes and] … you have to see them once a year to do their blood pressure and height and weight and all that, check their feet and that kind of thing. But other than that, it’s all just talking, so that has been really easy to use [for virtual visits]. A lot of my patients have hypertension and a lot of my patients have blood pressure machines, so they just send me a picture of their readings, and we can manage blood pressure that way”
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Virtual visits are beneficial for a range of patients but PCPs are concerned some might overuse or inappropriately use them | “I think it could be used for everybody. Really, I’m not that specific in the certain type of persons that I ask to come on [in]. I’m pretty all access. As long as they can use a computer, I’m like, here, this will probably be worth it for you” “My initial expectation was that younger patients were more friendly with technology and would be using this. Although I have had patients who are older, over 65, using this successfully as well. I think in today’s age everybody is comfortable with using a computer and logging into a website and sending a message”
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| “Geriatric patients are people who have more needs, basically, which tends to be the older patients, the anxious patient, the young mom or the new mom with young kids, somebody with patients that are disabled that they are taking care of” “I’m also picking people that live further away. So, people that live at a distance where if they needed something as simple as a medication refill, I could probably handle that through an [electronic visit]”
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| “I guess there are people that need constant reassurance in stuff for whatever reason, whether it’s mental or physical, and come to the office a lot. Those are people that I think, in general, might overuse it [virtual visits], and I think they’re probably better assessed in the office face to face” “I think part of it comes down to patient education, just like anything else, maybe, providing access to that anxious patient. If there is abuse or overuse of it or misuse of it [virtual visits], then it’s educating the patient or even taking that privilege away”
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PCPs prefer to use asynchronous messaging for its flexibility | “When [telephone] and voicemail come in the [telephone] messaging is not necessarily clear. And sometimes we do not necessarily hear what people are saying to us. And we have to answer in real time, which forces us to not necessarily give the best response … [W]ith asynchronous text messaging, e-mail, or otherwise—you get to wait, you get to sit. You do not have 3 other patients asking you questions while they are sitting in the front. So, you can wait and take a deep breath and then answer these questions” “I like the asynchronous messaging. I like that it gives me time to come back and finish the encounter when needed, when I have time”
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| “I’m less willing to use the video and the [telephone], because the [telephone] is harder to schedule … whereas with messaging, I’ve got a distinct question to answer and I can constrain it [the visit] better” “I think if you just have texting or messaging, there would be some limitations in what you could do. While video is used in a minority of cases, those are probably important cases, and that likely avoids an in-person visit, which is what we’re trying to do”
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Virtual visits can provide value at the patient, provider, and health system levels | “I really love that there is an option for my patients other than necessarily trying to get through on the [telephone] at certain times, which is not convenient for them. And I love the fact that it’s convenient for them and it’s also convenient for me because I can do it when it’s good for me” “It’s a workload and time saver for the way that patients otherwise would access that kind of service, right, which is through my office staff and I think a huge waste of time with multiple layers of communication that’s required in order for me to answer one of their questions” “I see it [virtual visits] more of getting rid of a lot of the menial work that patients come and book a 5-minute appointment for, and then end up asking 2 or 3 other questions that, in and of themselves would never be a visit … and so, it helps to speed up the process, helps to improve wait times because now it’s not being looked at with all this other stuff, and it helps [with] patient satisfaction because now they feel like they have a direct connection to physician”
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| “For practices that don’t have good access for patients, I would hope that by improving patients’ access to ask questions, clarify things, do some virtual primary care, that it would decrease walk-in utilization and then hopefully decrease emergency [department] visits” “I think I’ve had people that would have made an appointment, but because … we were able to do it virtually, it saved them from booking an appointment or possibly going to even a walk-in clinic” “I know that if my patients go to the walk-in [clinic], 50% of those visits will be repeated. If they see me, they often don’t have to repeat their visit. So, as much as I can do to keep it within the house, it improves my access bonus, which is good, but more importantly it keeps the continuity of care, which has been shown very clearly to improve outcomes for patients. It’s the most efficient, most effective system”
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