Nephrologist Perspectives on Using Telemedicine During In-Center Hemodialysis: A Qualitative Study.

Abstract

Rationale & objective: During the coronavirus disease 2019 (COVID-19) pandemic, the United States (US) government expanded originating telemedicine sites to include outpatient dialysis units. For the first time, nephrology care providers (nephrologists and affiliated advanced practice providers) across the US could use telemedicine in lieu of face-to-face visits to deliver care for patients receiving in-center hemodialysis. In this study, we describe perspectives and experiences of nephrologists using telemedicine to deliver in-center hemodialysis care.

Study design: Qualitative research study.

Setting & participants: Nephrologists in three health systems who used telemedicine for in-center hemodialysis during the COVID-19 pandemic.

Analytical approach: We conducted 16 semi-structured telephone interviews. Transcripts were thematically analyzed.

Results: We identified five themes and respective subthemes: maintaining safety and quality of care (making up missed appointments, fostering continuity of care, addressing urgent medical issues); maximizing efficiency (reducing nephrologist's travel burden, allowing for flexibility); operational complexities (dependence on facility resources; challenges coordinating with facility staff; modifying visit duration/length); diminished depth of clinical encounters (excess formality, constrained communication, incomplete physical exams); supporting confidence in telemedicine (complementing in-person care, accounting for patient preferences, requiring reimbursement).

Limitations: The transferability of the findings outside of an urban academic setting is uncertain.

Conclusion: Although nephrologists encountered operational (both technical and personal level) challenges such as communication constraints when using telemedicine for in-center hemodialysis care, they reported improvements in aspects of care quality and enhanced efficiency. These findings inform the potential use of a hybrid in-center hemodialysis care delivery model in which telemedicine supplements in-person visits.