Table 2.
Themes, Categories, Codes and Illustrative Quotes from High-Risk Primary Care Participants
| THEME | CATEGORY | CODE | REPRESENTATIVE QUOTE |
|---|---|---|---|
| UTILITY | Clinical Utility | Diagnostic Efficacy | “But with technology, I don’t think it’s gonna show you everything you need or maybe you gonna lose something that could be vital to the situation.” (AP78) |
| Focus | “And when you’re talking to somebody, you forget things or you overlook things. When you’re there personally, you have a chance to review the things… You remember things that you don’t normally remember, you could bring it up.” (FP87) | ||
| Communication | “It’s just a certain way of communicating with an individual. I’m able to sense them, just like they are able to sense me up and see just what the doctor is– where he or she is coming from, to evaluate their bedside manner.” (AP78) | ||
| Non-Clinical Utility | Altruism | “I would be more than happy to learn that which I need to learn to do my part in alleviating, you know, because I am sure it’s a very difficult time for all of us, including the doctors. So as long as that’s not algebra, I can’t see why I couldn’t [use telemedicine].” (MP013) | |
| Social Connection | “I get to see lots of people. Lots of different people. And like I said everyone’s pleasant. I get to even eat something that I enjoy eating there.” (JP27) | ||
| COSTS | Time | “It’s great. I don’t have to figure out a ride to get down to the doctor’s office…So, it’s easy. I can just sit in my living room, take the call, and go take a nap afterwards.” (MN3375) | |
| Money | “On technology, when I think about it, it should be cheaper because they’re not really doing that much.” (AP78) | ||
| Effort | “Once the pandemic is over, I would want to go into the office. There’s no point of the video, because you’ll still have to get blood work, so it’s kind of like a double thing you have, like a double thing, might as well see them if they’re going to take the blood from me anyway.” (JP821) | ||
| Safety | Loss of Privacy | “It [video visit] doesn’t bother me, I pretty much, I kind of like it because you get that one-on-one setting and you know, there is nobody there looking over your shoulders. It’s really helpful because you can be in the privacy of your own home.” (JP57) | |
| Loss of Health | “The positive in this particular case is that I didn’t have to go into an environment where the COVID virus might be floating about thereby my risk of contracting it was reduced by virtue of this telemedicine, teledoc or telemedicine visit. That was a good thing.” (DE313) | ||
| Emotional Distress | “And I’m sitting there, I had my computer open, I’m looking for a phone number: why can’t I see this? why isn’t it happening? … It’s nerve wracking if you never did it.” (DP83) | ||
| MODIFIERS | Clinical Situation | Acuity | “It all really depends on how I feel, you know what I mean? If I felt like it was something that would need to be, an emergency thing, then I would want [my PCP] to see it [in-person], or whatever.” (JP57) |
| Uncertainty | I was concerned about a couple of things that had been ongoing and I think he needed not only to look at them but investigate, which is something you can’t do through a video. (JT47) | ||
| Exam Relevance | Well, if I’m going through an issue that requires her to examine me, you can’t do that over the phone. (JP66) | ||
| Choice Availability | Authorization | “And [PCP] gave me that option. She had told me, ‘If you feel something going on or if something is going on with you,’ and if I had that, like she told me, it could be over the phone or I could come. So she gave me that choice.” (JP57) | |
| Awareness | “You know, I think there– I think I was invited to do a televisit and it never occurred to me to ask for it otherwise.” (MV27) | ||
| Access | “I don’t have that type of phone that I can do a video on, and I don’t have a computer. So that’s all I could do was a phone chat.” (FP81) | ||
| Decision Phenotype | Assertiveness | “It’s not a big deal for me, if that’s what’s needed I’m pretty easy to go. I’m – whatever I need, that’s what I’ll get. If [the health system] is offering it, I’m taking it… I’m real easy, I’m telling you. Whatever is good for them, and if I don’t need anything I’m fine with it. I have good doctors so, if I’m having a problem they take care of it immediately.” (JP27) | |
| Biases | “First of all, I’m an adventurous person and this is something new and I always like to try new things. When this was presented to me as an option, I thought, sure. Why not? Let’s try that, see how it works.” (DE313) | ||
| DRIVERS | Background Experiences | “You know since I’ve been in and I do have the rapport with him [PCP], I would feel comfortable [having an audiovisual visit] if something really was worrying me.” (AB413) | |
| Digital Environment | Tech Familiarity | “It’s hard for me to do the texting, and as far as the computer itself, like going online, I am really computer illiterate.” (FP81) | |
| Access Logistics | “I don’t deal with the phones and stuff like that…. I’d get somebody to teach me how to get the person on the phone or something…I would have to hook up a family friend to get me to do that.” (JP47754) | ||
| Use Logistics | “I could see the video of the doctor, but the [video visit platform]…wouldn’t come up and I got tired of trying.” (JP821) |
See Fig. 1, “Framework of the Factors Influencing High-Risk Patients’ Choice of Telehealth Use” for a graphic representation of the Themes and Categories outlined above