TABLE 4.

Key qualitative themes for patients and clinical provider perceptions of telehealth headache services

	Pre COVID‐19 pandemic themes	Illustrative interview quotes	During COVID‐19 pandemic themes	Illustrative interview quotes
Patient perspectives	Telehealth decreases the impact of medical appointments on daily responsibilities	“I would love to do if I could do visits from home, that would be super simple for me in my workday. If that’s something I could do then that would be fantastic”	Traditional in‐person visits are still desirable for some, but attendance impact ability to engage in daily responsibilities	“I have to drive 45 minutes, and then by the time I’m done sitting in the bright lights and, you know, all these things kinds of stress and everything adds up so that I realize my headache’s getting worse”
	Telehealth improves access to headache specialists	“It would be [helpful]. We have some guys that drive over 100 miles”
	Telehealth is comparable to in‐person care and even enhances patient experience	“I like that I get to sit in a comfortable environment and I’m not having to drive in. I get more out of it than going to the appointment. With me the providers even seem calmer. I don’t feel like they’re rushing from one patient to next. Telehealth has been great for me”
	Traditional in‐person visits have disadvantages	“By the time I get here, I sit and I wait, and then I’m in the room with the bright lights, and then I have to drive 45 minutes home, the whole process ends up being a headache‐inducing day”	Telehealth improves access but requires availability of technology and connectivity	“I don’t have a cell phone. I don’t have a home computer. I’ve got a tablet, but you know, I’m not a tech guru. I just would probably have to be walked through it I’m sure”
Provider perspectives	Use of telehealth differs for initial encounters vs. follow‐up visits	“Telehealth is awesome for headaches, especially follow‐ups. Initial evals with the complicated headache patients, probably not the best. But a follow‐up just to see how things are going or just to check in and make sure that you don’t need to make any medication adjustments, that’s perfect”	Improvements in access have occurred due to telehealth	“Headache is probably the easiest one to do virtually. I think we’ve been more agile than we probably would’ve been previously because we’re able to see more people from a distance to have to come all the way for an hour to get a headache eval that we could do via video connect or phone”
	Telehealth improves access to headache specialists	“We have a lot of Vets that come from a distance as a barrier”	Use of multiple delivery methods/tools for telehealth is essential to enhance patient engagement	“I’ll try to do an exam over the VVC even with its delays, and then we’ll just switch to a telephone call. Some people can’t connect that all, and that has to do with ‐ mostly I think it’s their WiFi connection, or their technological ability”
	Appropriate infrastructure is essential for telehealth headache care	“I’m not trained, and I want to do it, and I know I need to do it. It’s just it’s very difficult”	Openness to utilize telehealth differs for initial encounters vs. follow‐up visits	I think [telehealth] is a very good alternative to face‐to‐face visits, especially for follow‐up visits, it’s absolutely non‐inferior to face‐to‐face visits”
			There is a range of telehealth adopters from early to late (COVID forced) with varying recognition of the benefits and drawbacks	“Well, you get everything. Some people love it, some people hate it, some people just don’t like the technology or they had a difficulty with it, but even people who don’t ‐ you know, eventually when they do get it, I think they like it. There’s people that travel so they don’t want to come in”

Abbreviations: COVID‐19, coronavirus disease 2019; VVC, VA Video Connect.