“Por la pantalla no se cura a nadie”: Barriers and facilitators to video telehealth for primary care among a Western MA Medicaid population

Type: Oral Presentation
Date: November 2022


Emily Hahn, Carolyn Fisher, Pallavi Goel, Roxanne James, Sofia Ladner, Paul Pirraglia, Molly Totman, Michelle Rys, Eric Vilar, & Christina Huebner Torres (Nov 2022). “Por la pantalla no se cura a nadie”: Barriers and facilitators to video telehealth for primary care among a Western MA Medicaid population. Presented at the 2022 APHA Annual Meeting and Expo (oral). Boston, MA.


Background: The BeHealthy Partnership is a Medicaid ACO that serves patients in five community health centers in Western MA.

Objective: By the end of the session, participants will understand decision-making about telehealth, as well as barriers and facilitators to telehealth use among BeHealthy ACO patients.

Methods: We conducted 35 semi-structured interviews with ACO members by phone in English or Spanish from November 2021 to January 2022.  We used a Framework analysis approach with qualitative analysis software (Dedoose version 9.0.46).

Results: Many patients do not view the choice between in-person and virtual care as their decision, instead they report accepting the mode of care their health system offers. Among patients who prefer in-person visits, many felt their conditions could be better understood with a physical examination. Some patients were also concerned about online privacy (e.g. security of personal information), as well as who was able to overhear the session, either on the patient or provider side. Major facilitators to telehealth use included convenience (having telehealth visits at home or work), increased physical safety from COVID-19, and reduced psychological stress about contracting COVID-19 during a healthcare visit.

Discussion: We expected to explore factors that influence patients’ decision-making around in-person or telehealth visits. Instead, we found that many patients experience a lack of involvement in this choice. The literature suggested that major barriers to video telehealth for Medicaid participants would include internet bandwidth, discomfort and distrust of technology, access to internet-capable devices, and health literacy. However, we found patients are most concerned about the lack of a physical examination over telehealth and the privacy of telehealth sessions. These factors are important when designing initiatives to promote telehealth access among Medicaid community health center populations, and future research is needed to understand this topic further.

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