Care Redesign to Support Telemedicine Implementation During the COVID-19 Pandemic: Federally Qualified Health Center Personnel Experiences

J Am Board Fam Med. 2023 Oct 11;36(5):712-722. doi: 10.3122/jabfm.2022.220370R2. Epub 2023 Aug 30.


Background: Federally qualified health centers (FQHCs) rapidly adopted and implemented telemedicine during the COVID-19 pandemic. This study analyzes FQHC personnel accounts of care redesign strategies to support telemedicine implementation in 2020 and 2021, and identifies improvement opportunities.

Methods: We conducted semistructured, in-depth interviews with clinic personnel (n = 15) at 2 FQHCs in Northern California (December 2020-April 2021) to examine telemedicine adoption and use of audio-video and audio-only/phone telemedicine encounters.

Results: FQHC clinicians and staff reported that telemedicine implementation increased access to care and reduced appointment no-show rates. However, a reported reduced ability to develop and foster interpersonal connections negatively impacted clinician-patient relationships. Care redesign strategies included systems to triage appointment types (in-person versus virtual), work-arounds to screen for and address social and nonmedical needs, and new protocols to navigate privacy needs for first time telemedicine users. In addition, increasing remote monitoring capabilities was deemed an important priority for improving telemedicine use for marginalized populations.

Conclusions: Telemedicine implementation in FQHCs involved care redesign to optimize virtual interactions and care processes. Guidelines and evidence-based practices are needed to improve telemedicine use in FQHCs, including strategies to support interpersonal connections; approaches to virtually screen for and address social needs; and protocols to further mitigate privacy issues. Future research is needed to identify when telemedicine can optimally supplement in-person care to improve patient outcomes and clinic efficiency, particularly in safety net settings.

Keywords: COVID-19; Community Health Centers; Health Services Accessibility; Implementation Science; Pandemics; Primary Health Care; Qualitative Research; Quality Improvement; Safety-Net Clinics; Telehealth.

MeSH terms

  • Ambulatory Care Facilities
  • COVID-19* / epidemiology
  • Health Personnel
  • Humans
  • Pandemics
  • Telemedicine* / methods