ODP637 Clinical Appropriateness of Telehealth: A Qualitative Study of Endocrinologists’ Perspectives
Authors: Bolton Rendelle , Sitter Kailyn , Wong Denise , Vimalananda Varsha 
Published: November 2022

Abstract

Background
The increase in outpatient endocrinology care delivered by synchronous video telehealth during the COVID-19 pandemic is likely to persist post-pandemic. There is little data to guide endocrinologists’ judgments of clinical appropriateness (safety and effectiveness) for telehealth. We sought to examine how endocrinologists determine clinical appropriateness for telehealth and identify strategies to navigate barriers to its safe and effective use.

Methods
We conducted qualitative, semi-structured interviews with 26 purposively selected US endocrinologists to explore how they determined which outpatient situations were safe and effective for synchronous video telehealth. We used a directed content analysis to identify perceptions of which patients and situations worked best with telehealth, and describe adaptations made to accommodate telehealth visits.

Results
Endocrinologists’ judgments about which patient visits were appropriate for telehealth were influenced by four factors: clinical considerations, non-clinical patient factors, purpose and timing of the visit, and clinician willingness to adapt to remote formats. These factors were weighed differently according to participants’ risk tolerances, values related to the physical exam and face-to-face interactions, and assumptions about patient capabilities and preferences. (1) Clinical considerations included medical complexity, availability of lab data, and perceived need for in-person physical exams. Participants agreed on appropriateness of uncomplicated thyroid disease for telehealth but disagreed about the need for in-person diabetic foot exams. (2) Non-clinical patient factors included patient age, tech literacy, and travel burden. Some participants believed older patients struggled with telehealth; others believed the opposite. (3) Purpose and timing of the visit included discussions of initial vs. follow-up visits, time since the last in-person visit, and the patient-clinician relationship. An established face-to-face patient-clinician relationship ameliorated participants’ concerns about telehealth related to communication, patient buy-in to care, and patient visit preparedness. (4) To increase telehealth safety and effectiveness, some participants adapted their practices to include teaching patients how to conduct physical exams independently or with coaching from the clinician, obtaining patient health data electronically, having patients complete required testing during visits to other clinicians, and planning for yearly face-to-face visits.

Conclusions
Judgments about appropriateness of telehealth for similar clinical situations were heavily subjective, and driven by individual values, perceptions of risk, and willingness to adapt established practice. This wide variation in judgments risks contributing to clinically inappropriate variation in the use of telehealth that, in turn, threatens equitable access to endocrinology care. Evidence-based guidelines on appropriate use of telehealth are needed and should be grounded in data on best practices and outcomes of telehealth vs. face-to-face care. In the absence of guidelines, consensus statements can provide interim guidance to endocrinologists on determining clinical appropriateness of telehealth so clinicians might feel comfortable honoring patient requests for telehealth.
Presentation: Sunday, June 12, 2022 12:30 p.m. - 2:30 p.m., Monday, June 13, 2022 1:18 p.m. - 1:23 p.m.