• Jiani Yu, Hyunkyung Yun, Mark A Unruh, Eloise M O'Donnell, Paul R Katz, Jessica S Ancker, and Hye-Young Jung.
• Department of Population Health Sciences, Weill Cornell Medical College, New York City, USA. jiy4002@med.cornell.edu.
• J Gen Intern Med. 2023 May 1; 38 (7): 172217281722-1728.

BackgroundDespite expanded access to telehealth services for Medicare beneficiaries in nursing homes (NHs) during the COVID-19 public health emergency, information on physicians' perspectives on the feasibility and challenges of telehealth provision for NH residents is lacking.ObjectiveTo examine physicians' perspectives on the appropriateness and challenges of providing telehealth in NHs.ParticipantsMedical directors or attending physicians in NHs.ApproachWe conducted 35 semistructured interviews with members of the American Medical Directors Association from January 18 through January 29, 2021. Outcomes of the thematic analysis reflected perspectives of physicians experienced in NH care on telehealth use.Main MeasuresThe extent to which participants used telehealth in NHs, the perceived value of telehealth for NH residents, and barriers to telehealth provision.Key ResultsParticipants included 7 (20.0%) internists, 8 (22.9%) family physicians, and 18 (51.4%) geriatricians. Five common themes emerged: (1) direct care is needed to adequately care for residents in NHs; (2) telehealth may allow physicians to reach NH residents more flexibly during offsite hours and other scenarios when physicians cannot easily reach patients; (3) NH staff and other organizational resources are critical to the success of telehealth, but staff time is a major barrier to telehealth provision; (4) appropriateness of telehealth in NHs may be limited to certain resident populations and/or services; (5) conflicting views about whether telehealth use will be sustained over time in NHs. Subthemes included the role of resident-physician relationships in facilitating telehealth and the appropriateness of telehealth for residents with cognitive impairment.ConclusionsParticipants had mixed views on the effectiveness of telehealth in NHs. Staff resources to facilitate telehealth and the limitations of telehealth for NH residents were the most raised issues. These findings suggest that physicians in NHs may not view telehealth as a suitable substitute for most in-person services.© 2023. The Author(s), under exclusive licence to Society of General Internal Medicine.

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