Telehealth Use for Kidney Disease Management Yields Low Satisfaction

Patients and clinicians found telehealth use convenient for chronic kidney disease management, but overall, the virtual modality yielded low satisfaction levels for clinical effectiveness, ease of use, and patient-clinician communication, a qualitative study published in JAMA Network Open revealed.

Massachusetts researchers interviewed 19 clinicians, 30 patients, and 11 care partners—people patients discuss healthcare decisions with—between August and December 2020 to understand their perceptions of using telehealth for chronic kidney disease management. The interviewees were spread out across Massachusetts, Illinois, Maine, and California.

Patients, care partners, and clinicians all agreed that using telehealth was convenient. One clinician noted that telehealth increased their availability to patients, while another mentioned the fact that patients did not have to spend time traveling or waiting once they arrived.

One patient also cited not having to travel to a clinic or hospital as a benefit of telehealth. Similarly, patients appreciated being able to stay home and receive care in an environment that they are comfortable in.

Care partners enjoyed the convenience of telehealth as well. Health systems restricted visitations during in-person visits due to the COVID-19 pandemic, and virtual care allowed care partners to be present with the patient. Both patients and clinicians mentioned how care partner participation improved the telehealth experience.

A few clinicians said that telehealth helped them better understand a patient’s home environment. Some clinicians mentioned that virtual care empowered patients to participate in their care, such as learning how to check their own blood pressure.

However, despite these noted benefits of using telehealth for chronic kidney disease management, patients and clinicians alike saw several downsides to the service.

A handful of clinicians reported that telehealth diminished care quality as some services, including lab tests and physical examinations, essentially require an in-person visit. A couple of patients raised this concern as well, saying that they did not necessarily feel confident in their ability to accurately record their own vitals at home. One patient also questioned a clinician’s ability to diagnose an individual over the phone.

Patients and clinicians were dissatisfied with the technical aspect of telehealth as well. Clinicians noted internet connection issues and general technology confusion as barriers. One patient expressed frustration about not being able to successfully navigate the telehealth platform.

Clinicians also reported an increase in missed appointments, as patients may be quicker to not show up to a telephone or video call compared to an office visit.

Additionally, telehealth may have hindered access to care for underserved populations due to socioeconomic disparities.

Not all patients have the financial means to access a device with video capabilities or stable broadband connection. In-person visits may also see more success for patients with limited English proficiency or older adults who lack adequate digital literacy skills to use telehealth, clinicians said.

Telehealth can also prove to be difficult for older patients with vision or hearing impairments, although one patient with hearing loss noted that video visits were helpful, as they would be unable to lip read in-person due to everyone wearing a mask.

Clinicians and patients touched on the lack of interpersonal connection that telehealth led to as well. Some patients noted that they enjoy seeing their doctor in person and the social conversation that accompanies the visit. Another patient said that they felt better connected to their clinician during an in-person visit compared to telehealth.

Clinicians mentioned an emotional disconnect that plagues telehealth visits. For example, one clinician described the struggle of trying to deliver bad news virtually and said it was easier to gauge emotional reactions in person.

Importantly, patients of color were less satisfied with telehealth compared to their white counterparts, the study noted. One patient who identified as Black said that they preferred in-person visits as they needed to see the doctor’s facial expressions throughout their visit.

Although telehealth may improve access to care, the study findings revealed that virtual visits may work best as a supplement to in-person care for certain patients. The results also suggest that further resources are needed to address care disparities and facilitate telehealth access for older adults and racial minorities.