"Nothing is going to replace an in-person visit": Canadian long-term care providers' and recipients' perspectives on when telehealth for physician visits is not appropriate.

Background: Within long-term care (LTC) homes, telehealth use has been found to reduce unnecessary emergency department transfers, support the care needs of rural and underserved communities, and supplement in-person physician care. Despite these benefits, it is not well understood when telehealth is not an appropriate medium for providing physician care to residents with complex health needs. This knowledge gap must be addressed given the recent rise in telehealth use in LTC homes in many health systems following the COVID-19 pandemic, when virtual care use increased in many health care sectors to limit travel and in-person exposure risks, that is expected to be maintained going forward. Methods: This analysis contributes to a broader evaluative study investigating care provider and care recipient experiences and preferences for physician telehealth in LTC homes within the Fraser Health region in British Columbia, Canada. For data collection, semi-structured interviews and focus groups were undertaken with seventy care providers (staff, physicians) and recipients (residents, family caregivers). Using a thematic approach, transcripts were analyzed to find common instances when using telehealth for physician care was seen as not appropriate across participant groups. Results: Three types of patient care activities were identified as not appropriate to be conducted via physician visits using telehealth. First, new patient visits were thought to benefit from an interpersonal and conversational familiarity that could not be supported by telehealth. Second, difficult in-depth conversations that required conversational nuance (e.g., eye contact, supportive body language), such as palliative care planning, were thought to be inappropriate for telehealth appointments. Finally, instances where LTC staff would need to perform hands-on clinical assessments on behalf of physicians who were attending virtually via telehealth were not seen as desirable. Conclusions: This analysis highlights perspectives surrounding when telehealth is not appropriate for providing physician services for residents in LTC based on the preferences and experiences shared by both care recipients and care providers. The findings present an opportunity to develop and implement guidelines on appropriate use of telehealth in LTC to support best care practices.