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

Authors

Trenton M Haltom
Susie Q Lew
Wolfgang C Winkelmayer
Glenn M Chertow
Allison Jaure
Kevin F Erickson

Publication Date

7-1-2024

Journal

Kidney Medicine

DOI

10.1016/j.xkme.2024.100848

PMID

38938646

PMCID

PMC11209005

PubMedCentral® Posted Date

5-22-2024

PubMedCentral® Full Text Version

Post-print

Published Open-Access

yes

Keywords

Hemodialysis, qualitative interviews, telemedicine

Abstract

RATIONALE & OBJECTIVE: In the wake of the coronavirus disease 2019 (COVID-19) pandemic, the United States federal government expanded originating telemedicine sites to include outpatient dialysis units. For the first time, nephrology practitioners across the United States could replace face-to-face visits with telemedicine for patients receiving in-center hemodialysis. This study describes patients' perspectives on the use of telemedicine during in-center hemodialysis.

STUDY DESIGN: A qualitative study.

SETTING & PARTICIPANTS: Thirty-two patients from underserved populations (older, less educated, unemployed, persons of color) receiving in-center hemodialysis who used telemedicine with their nephrologist during the COVID-19 pandemic.

ANALYTICAL APPROACH: Telephone semistructured interviews were conducted in English or Spanish. Transcripts were thematically analyzed.

RESULTS: We identified 6 themes with subthemes: adapting to telemedicine (gaining familiarity and confidence, overcoming and resolving technical difficulties, and relying on staff for communication); ensuring availability of the physician (enabling an immediate response to urgent medical needs, providing peace of mind, addressing patient needs adequately, and enhanced attention and contact from physicians); safeguarding against infection (limiting COVID-19 exposures and decreasing use); straining communication and physical interactions (loss of personalized touch, limited physical examination, and unable to reapproach physicians about forgotten issues); maintaining privacy (enhancing privacy and projecting voice enables others to hear); and supporting confidence in telemedicine (requiring established rapport with physicians, clinical stabilty of health, and ability to have in-person visits when necessary).

LIMITATIONS: Interviews were conducted later in the pandemic when some nephrology care providers were using telemedicine infrequently.

CONCLUSIONS: Patients receiving in-center hemodialysis adapted to telemedicine visits by their nephrologists in the context of the COVID-19 pandemic and observed its benefits. However, further considerations regarding communication, privacy, and physical assessments are necessary. Integrating telemedicine into future in-center hemodialysis care using a hybrid approach could potentially build trust, optimize communication, and augment care.

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