The rapid deployment of video visits during COVID-19 may have posed unique challenges for home-based primary care (HBPC) practices due to their hands-on model of care and older adult population. This qualitative study examined provider perceptions of video visits during the first wave of the COVID-19 crisis in New York City (NYC) through interviews with HBPC clinical/medical directors, program managers, nurse practitioners/nurse managers, and social work managers (n = 13) at six NYC-area practices. Providers reported a combination of commercial (health system-supported) and consumer (e.g., FaceTime) technological platforms was essential. Video visit benefits included triaging patient needs, collecting patient information, and increasing scheduling capacity. Barriers included cognitive and sensory abilities, technology access, reliance on caregivers and aides, addressing sensitive topics, and incomplete exams. Effectively integrating video visits requires considering how technology can be proactively integrated into practice. A policy that promotes platform flexibility will be crucial in fostering video integration.
AbrashkinK. A.PokuA.BallT.BrownZ. J.RhodesK. V. (2020). Ready or not: Pivoting to video visits with homebound older adults during the COVID-19 pandemic. Journal of the American Geriatrics Society, 68(11), 2469–2471.
2.
BakerP.HansonJ.MyhillW. N. (2009). The promise of municipal WiFi and failed policies of inclusion: The disability divide. Information Polity, 14(1–2), 47–59.
CreswellJ. W. (2012). Qualitative inquiry and research design: Choosing among five approaches. SAGE.
5.
DangS.PenneyL. S.TrivediR.NoelP. H.PughM. J.FinleyE.. . . LeykumL. (2020). Caring for caregivers during COVID-19. Journal of the American Geriatrics Society, 68, 2197–2201.
6.
DesaiN. R.SmithK. L.BoalJ. (2008). The positive financial contribution of home-based primary care programs: The case of the Mount Sinai Visiting Doctors. Journal of the American Geriatrics Society, 56(4), 744–749.
7.
Eric De JongeK.JamshedN.GildenD.KubisiakJ.BruceS. R.TalerG. (2014). Effects of home-based primary care on Medicare costs in high-risk elders. Journal of the American Geriatrics Society, 62(10), 1825–1831.
8.
FranzosaE.GorbenkoK.BrodyA. A.LeffB.RitchieC. S.KinosianB.. . . FedermanA. D. (2021). “At home, with care”: Lessons from New York City home-based primary care practices managing COVID-19. Journal of the American Geriatrics Society, 69(2), 300–306.
9.
GubaE. G. (1981). Criteria for assessing the trustworthiness of naturalistic inquiries. Ectj, 29(2), 75-91.
JainR.DasariS.SorianoT.DeCherrieL.KerrL. D. (2011). Rheumatologists on the road: A subspecialist’s role in caring for the homebound. Arthritis Care & Research, 63(10), 1482–1485.
12.
KalickiA. V.MoodyK. A.FranzosaE.GliattoP. M.OrnsteinK. A. (2021). Barriers to telehealth access among homebound older adults. Journal of the American Geriatrics Society. Advance online publication. https://doi.org/10.1111/jgs.17163
13.
KimE.GellisZ. D.BradwayC.KenaleyB. (2019). Key determinants to using telehealth technology to serve medically ill and depressed homebound older adults. Journal of Gerontological Social Work, 62(4), 451–474. https://doi.org/10.1080/01634372.2018.1499575
14.
KozikowskiA.ShotwellJ.WoolE.SlabodaJ. C.AbrashkinK. A.RhodesK.. . .NormanG. J. (2019). Care team perspectives and acceptance of telehealth in scaling a home-based primary care program: Qualitative study. JMIR Aging, 2(1), e12415. https://doi.org/10.2196/12415
15.
LamK.LuA. D.ShiY.CovinskyK. E. (2020). Assessing telemedicine unreadiness among older adults in the United States during the COVID-19 pandemic. JAMA Internal Medicine, 180(10), 1389–1391.
16.
Latus-OlaifaO.NormanG. J.KurliandM.SlabodaJ. C.AbrashkinK. A.SmithK. L.. . . RhodesK. (2019). Not yet ready for prime time: Video visits in a home-based primary care program. Journal of the American Geriatrics Society, 67(10), 2202–2204.
17.
LeffB.WestonC. M.GarriguesS.PatelK.RitchieC. (2015). Home-based primary care practices in the United States: Current state and quality improvement approaches. Journal of the American Geriatrics Society, 63(5), 963–969.
18.
LincolnY. S.GubaE. G. (1986). But is it rigorous? Trustworthiness and authenticity in naturalistic evaluation. New Directions for Program Evaluation, 1986(30), 73-84.
19.
NowellL. S.NorrisJ. M.WhiteD. E.MoulesN. J. (2017). Thematic analysis: Striving to meet the trustworthiness criteria. International Journal of Qualitative Methods, 16(1), 1-13.
20.
OrnsteinK. A.GarridoM. M.Bollens-LundE.HusainM.FerreiraK.KelleyA. S.SiuA. L. (2020). Estimation of the incident homebound population in the U.S. among older Medicare beneficiaries, 2012 to 2018. JAMA Internal Medicine, 180, 1022–1025.
21.
OrnsteinK. A.LeffB.CovinskyK. E.RitchieC. S.FedermanA. D.RobertsL.KelleyA. S.SiuA. L.SzantonS. L. (2015). Epidemiology of the homebound population in the United States. JAMA Internal Medicine, 175(7), 1180–1186.
22.
PepperL.MichenerA.KinosianB. (2019). House Call Practices in 2014: Mismatch of providers, practices, and patients. Journal of the American Geriatrics Society, 67, S4-S4.
23.
RitchieC. S.LeffB. (2018). Population health and tailored medical care in the home: The roles of home-based primary care and home-based palliative care. Journal of Pain and Symptom Management, 55(3), 1041–1046.
24.
SarkarU.KarterA. J.LiuJ. Y.AdlerN. E.NguyenR.LopezA.SchillingerD. (2011). Social disparities in internet patient portal use in diabetes: Evidence that the digital divide extends beyond access. Journal of the American Medical Informatics Association, 18(3), 318–321. https://doi.org/10.1136/jamia.2010.006015
25.
SchuchmanM.FainM.CornwellT. (2018). The resurgence of home-based primary care models in the United States. Geriatrics, 3(3), 41.
26.
ShacharC.EngelJ.ElwynG. (2020). Implications for telehealth in a postpandemic future: Regulatory and privacy issues. Journal of the American Medical Association, 323(23), 2375–2376.
27.
SocioCultural Research Consultants, LLC. (2015). Dedoose Version 6.1.18, web application for managing, analyzing, and presenting qualitative and mixed method research data. Dedoose.
28.
SterlingM. R.DellN.PiantellaB.ChoJ.KaurH.TsengE.. . . KernL. M. (2020). Understanding the workflow of home health care for patients with heart failure: Challenges and opportunities. Journal of General Internal Medicine, 35, 1721–1729.
29.
SterlingM. R.TsengE.PoonA.ChoJ.AvgarA. C.KernL. M.. . . DellN. (2020). Experiences of home health care workers in New York City during the coronavirus disease 2019 pandemic: A qualitative analysis. JAMA Internal Medicine, 180, 1453–1459.
30.
TongA.SainsburyP.CraigJ. (2007). Consolidated Criteria for Reporting Qualitative Research (COREQ): A 32-item checklist for interviews and focus groups. International Journal for Quality in Health Care, 19(6), 349–357.
31.
WillinkA.DuGoffE. H. (2018). Integrating medical and nonmedical services—The promise and pitfalls of the CHRONIC Care Act. The New England Journal of Medicine, 378(23), 2153–2155.
32.
WosikJ.FudimM.CameronB.GelladZ. F.ChoA.PhinneyD.. . . FerrantiJ. (2020). Telehealth transformation: COVID-19 and the rise of virtual care. Journal of the American Medical Informatics Association, 27(6), 957–962.
Supplementary Material
Please find the following supplemental material available below.
For Open Access articles published under a Creative Commons License, all supplemental material carries the same license as the article it is associated with.
For non-Open Access articles published, all supplemental material carries a non-exclusive license, and permission requests for re-use of supplemental material or any part of supplemental material shall be sent directly to the copyright owner as specified in the copyright notice associated with the article.
