With the onset of the COVID-19 pandemic, telemedicine has become a new norm for many routine and non-emergency medical needs. But there are lessons to be learned from telemedicine’s use – or lack thereof – prior to the pandemic, and a new study from a UConn School of Social Work researcher offers insight for policymakers, administrators, and public health officials when considering the implementation of new services.
A qualitative researcher, lead author and licensed clinical social worker Kelsi Carolan was brought into the study – which was conducted in 2017 and 2018 and was recently published in the Journal of Medical Internet Research – to examine the adoption of a telemedicine program in a California independent senior living community.
“Initially, the study was purely looking at stats, seeing what the effects of this intervention would be, if any, on the unnecessary use of emergency transport – residents being transferred to the emergency department,” Carolan says. “What my co-authors were seeing in the numbers was that it wasn’t having much of an effect. The intervention didn’t seem to be working.”
Despite the fact that the program was being offered at no cost to residents, and despite a push from the community’s administration to utilize the program for cases that were not medically urgent, telemedicine wasn’t actually reducing the number of emergency room visits amongst residents in the community. The intervention uptake was low, and the researchers wanted to better understand why.
Carolan and her co-authors conducted separate focus groups with frontline, emergency-trained staff members and with residents from the community. The residents included both individuals who had previously used the telemedicine option as well as those who had not. Overall, the residents expressed a desire to avoid emergency room visits as much as possible – they disliked the long wait times, financial costs, and potential health risks of visiting the emergency room.
Some residents said the telemedicine option had helped avoid an unnecessary trip, while another said that their telemedicine experience actually reinforced the need to go to the emergency room despite the resident’s initial hesitancy – an unexpected benefit that helped diagnose a serious heart condition and ultimately led to important treatment.
The perceptions and experiences of the residents, however, were often in direct contradiction to the opinions of the community’s frontline staff, who reported in their focus groups that residents were reluctant to use the telemedicine option and did not directly request it. The staff felt that telemedicine ultimately just delayed an otherwise inevitable trip to the emergency room, seeing it as an obstacle to providing care to the community’s residents and not a valuable tool.
“Staff were saying it’s not appropriate for emergency care, and most folks need to go to the emergency room,” says Carolan, who has previously conducted qualitative research looking at a community paramedicine intervention. “It really made me think about my previous work and how much of a culture shift it is to ask emergency-trained responders, like EMTs and paramedics, to start to think about preventing emergency transport. Especially EMTs, because it’s just not what they’re trained to do. It’s really asking a profession to change its whole culture and training.”
The researchers ultimately concluded that a key barrier to the telemedicine program’s successful implementation was this resistance from staff, though Carolan says the COVID-19 pandemic may well have helped to change those cultural perspectives within the profession.
“I have faith that people who go into emergency care careers, like EMTs – they really want to help people,” she says. “There’s room for change if there is increased recognition among these frontline providers that sending people to the emergency room unnecessarily is not actually helping them and may actually cause harm….