Table 2 Potential impact of scheduled telephone visits in the VHA according to PACT principles and stakeholder assessments*
From: Scheduled telephone visits in the veterans health administration patient-centered medical home
PACT principles | Analytic themes | Patients | Providers | Staff |
|---|---|---|---|---|
Comprehensiveness: Primary care as point of contact for range of patient needs, including mental and physical health | Using scheduled telephone visits for routine physical and mental health issues | Routine visits that do not require physical examination (eg, chronic disease monitoring or mental health check-in/follow-up); Determine need for in-person visit | Routine visits that do not require physical examination (eg, chronic disease monitoring); Determine need for in-person visit | Routine visits that do not require physical examination (eg, chronic disease monitoring) |
Defining scope of scheduled telephone visits- how focused should they be? | General issues | Focused issues | General issues | |
Patient-centeredness: Focus on patient wants, needs and preferences | Engaging patients in determining scheduled telephone visit usage | For those who choose; want flexibility to change to in-person visits if not comfortable | For those who chose | Can improve patient satisfaction with more patient control over issues discussed |
Dealing with patients who have adherence or communication challenges | Could be beneficial for patients anxious about facing provider | For those who are “compliant” and do not have cognitive/verbal difficulties | Concern about liability with higher risk patients (eg, unable to communicate well over the phone) | |
Continuity: Established and sustained relationship with primary care provider | Ensuring availability of providers. | Maintain provider awareness of decisions or subjects discussed via telephone; concern about impersonal aspects of remote encounters | Better for patients with established provider relationships; | Maintain provider awareness of decisions or subjects discussed via telephone and some direct patient contact with providers |
Strengthening quality of patient-provider relationships | Better for patients with established provider relationships and can help strengthen relationships with more frequent contact | Can help maintain relationships and improve care quality if patients use preferred mode |