Perceived Barriers and Facilitators to the Adoption of Telemedicine Infectious Diseases Consultation in Southeastern Missouri Hospitals

Background and Purpose: Telemedicine infectious diseases consultation (tele-ID consult) has been used to provide clinical healthcare to underserved or resource-limited communities. Tele-ID consults provide improved access to care, patient satisfaction, and favorable clinical outcomes. However, there is a dearth of knowledge on factors that promote or hinder the adoption and implementation of tele-ID consults in low resource settings.

This study seeks to fill this gap by identifying and describing the perceived barriers and facilitators to the adoption and implementation of tele-ID consults at three rural hospitals in southeastern Missouri. Additionally, drawing on their own experiences, participants offer suggestions regarding the best ways to adopt and implement tele-ID consults effectively.

Methods: Fifteen in-depth, semi-structured interviews were conducted with a purposively sampled group of information-rich hospital stakeholders with experience in hospital leadership, administration, and healthcare delivery. This qualitative study was conducted at three rural, southeastern Missouri hospitals with partial or no on-site availability of infectious disease physicians. Participants were recruited via existing contacts and their connections at the three hospitals. Our interview guide, based on the literature, elicited participants' knowledge and experience with tele-ID Consults, their perceptions on infectious diseases consultation needs, and what they felt would be barriers of and facilitators to adopting and implementing telemedicine infectious diseases consultation. Thematic analysis was conducted to identify core themes related to facilitators and barriers to tele-ID consult. Two members of the study team with experience in qualitative research independently coded interview transcripts using an iterative process of inductive analysis. We created and modified our codebook as new codes and themes emerged. A third coder helped resolve any disagreements until we reached consensus.

Results: Common barriers to adopting and implementing telemedicine infectious disease consultations in three rural hospitals include logistical and technological challenges, negative emotional responses, patient-related factors, perceived quality of telemedicine, and legal concerns. These barriers highlight the significant challenges related to the operational and technical feasibility of adopting and implementing tele-ID consults. Moreover, they point to the complexities and difficulties around utilization and concerns about the burden to patients, physicians, and other medical staff. Major facilitators identified are perceived telemedicine infectious disease consultation needs, perceived benefits to patients and physicians, flexibility, openness to change, telemedicine champions, and prior experiences. Several participants report that the suitability, flexibility, and amenability of tele-ID consults to the infectious diseases' procedures, context, and situations give it a relative advantage compared to the current service model.

Conclusions and Implications: Our findings demonstrate that rural hospitals need telemedicine infectious disease consultations, have the potential capacity to implement them, but operational and technical feasibility challenges remain. Adoption and implementation tele-ID consults will likely reduce service gaps, shortage of physicians, and improve patient experience and satisfaction.