Assessing perceptions of patient-centered care during telehealth visits provided via rural county Extension offices: an implementation pilot study.

Background: The use of telehealth to deliver healthcare remotely has increased significantly over the past two decades. Despite increased use among certain demographic groups, uptake among rural populations continues to lag when compared to urban populations. Barriers such as limited access to the internet and patient perceptions regarding the lower quality of remote visits on patient-provider relationships may contribute to lower use among rural populations. Telehealth delivered in community settings like County Extension offers an innovative opportunity to reduce these barriers and associated disparities among rural communities. The aim of the current pilot study was to assess the implementation of telehealth kiosks in a rural community setting. Methods: In this cross-sectional, implementation pilot study, we utilize a mixed methods approach to assess patient centered care (PCC) among adults dwelling in rural areas and using telehealth services at their local County Extension offices. Twenty-one participants across four counties enrolled and completed telehealth visits with a nurse practitioner working in a well-known academic medical center's endocrinology clinic. Telehealth visits were audio recorded, transcribed professionally, and members of the research team analyzed the transcripts. Patients completed paper and pencil questionnaires at the end of their visit and data were entered into RedCap. Questionnaire data was analyzed for descriptive statistics. Results: This article describes aspects of patient centered communication through analysis of patient-clinician conversations during recorded telehealth visits and patients' responses on a paper questionnaire assessing self-reported scores on the revised Patient Perceptions of Patient-Centeredness (PPPC-R) questionnaire. Patients reported scores indicative of positive perceptions of PCC during their visits. The self-reported data from questionnaires and the transcripts from the audio recording supported this finding. We also provide an overview of lessons learned from testing the implementation of a novel health information technology in a non-traditional setting. Conclusions: Overall, telehealth is a feasible option for helping to reduce transportation and internet barriers while increasing access to specialty care in rural communities. Using a unique combination of implementation and communication science frameworks will help us to understand and define best-practices, collaboration networks and strategies for the effective use of telehealth in rural settings.