Barriers and Facilitators to Psychologists’ Telepsychology Uptake during the Beginning of the COVID-19 Pandemic
Abstract
:1. Introduction
2. Method
2.1. Participants
2.2. Procedure
2.3. Measures
3. Results
3.1. Descriptive Analyses
3.2. Logistic Regression
3.3. Barriers
3.4. Facilitators
4. Discussion
Limitations and Future Directions
5. Conclusions
Author Contributions
Funding
Institutional Review Board Statement
Informed Consent Statement
Data Availability Statement
Conflicts of Interest
References
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Characteristics | ||
---|---|---|
Age, M, SD | 57.29 | 11.42 |
Years in Practice, M, SD | 24.22 | 11.03 |
Gender, N, % | ||
Woman | 1681 | 64.2 |
Man | 928 | 35.4 |
Genderqueer | 3 | 0.1 |
Gender Non-conforming | 3 | 0.1 |
Transman | 2 | 1.0 |
Transwoman | 1 | 0.0 |
Intersex | 1 | 0.0 |
Race/Ethnicity, N, % | ||
White/European-American | 2385 | 91.1 |
Latinx/Hispanic | 61 | 2.3 |
Asian/Asian-American (NH/NL) | 50 | 1.9 |
Black/African-American (NH/NL) | 50 | 1.9 |
Multiracial/Multiethnic | 40 | 1.5 |
Other | 30 | 1.1 |
American Indian/Alaska Native/Native American | 3 | 0.1 |
Primary Practice Setting, N, % | ||
Individual Practice | 1424 | 54.4 |
Group Practice | 397 | 15.2 |
Hospital/Medical Center | 178 | 6.8 |
Academic Medical Center | 126 | 4.8 |
Other | 116 | 4.4 |
School/University | 113 | 4.3 |
Outpatient Treatment Facility | 99 | 3.8 |
Veterans Affairs Medical Center | 80 | 3.1 |
Geriatric Facility | 23 | 0.9 |
Psychiatric Hospital | 20 | 0.8 |
Correctional Facility | 19 | 0.7 |
Rehabilitation Center | 13 | 0.5 |
Residential Treatment Center | 11 | 0.4 |
Practice Location, N, % | ||
Suburban | 1229 | 46.9 |
Urban | 1150 | 43.9 |
Rural | 240 | 9.2 |
Number of Psychologists in Practice, N, % | ||
1 | 1177 | 44.9 |
2–5 | 864 | 33.0 |
6–10 | 246 | 9.4 |
11–20 | 182 | 6.9 |
21–50 | 82 | 3.1 |
50+ | 68 | 2.6 |
Barriers | |
---|---|
Code | Description |
Higher Cost for Patient or Provider | Concern for financial costs associated with obtaining, implementing, and maintaining telepsychology equipment |
Legal and Health Insurance Portability and Accountability Concerns | Statements regarding the legality of telepsychology or HIPAA regulations governing its use |
Inadequate Access to Teletechnology | Concern for inability to access technology necessary for telepsychology (e.g., lack of high-speed Internet in rural locations or inability to purchase a smartphone/laptop) |
Inadequate Reimbursement | Concern for inadequate reimbursement for telepsychology services from insurance, Medicare, etc. |
Insufficient Telepsychology Training | Statements endorsing a lack of training in telepsychology services or policies and procedures |
Diminished Therapeutic Alliance | Concern for how the lack of in-person interaction might affect the therapeutic alliance |
Inefficient Use of Time | Statements regarding wasted time (e.g., setting up or troubleshooting telepsych issues) |
Lack of Leadership Support for Telepsychology | Statements regarding a general dislike/distrust of telepsychology by one’s employer |
Diminished Quality of Delivered Care or Effectiveness | Includes concerns regarding efficacy, effectiveness, and the need for more research on telepsychology |
Lack of Patient Demand | Statements regarding patients either disliking telepsychology or preferring to meet in person |
Provider Dislike of Telepsychology | Statements indicating a general dislike of telepsychology without giving a specific reason |
Ethical Concerns | Statements questioning the ethicality of telepsychology |
Safety Concerns | Expressions of worry for remote clients who may be in crisis or at risk of harm to self or others |
Privacy Concerns | Expressions of worry for remote clients who may not have a private space to engage in therapy or inability for the provider to verify privacy, and also includes concerns over someone hacking into the session |
Technological Issues | Includes statements that the technological requirements for telepsychology are currently inadequate or unreliable (e.g., poor connectivity or quality) as well as statements regarding the need for troubleshooting that do not reference “time” |
Incompatible with Certain Services | Statements questioning the efficacy of telepsychology for a specifically named services (e.g., play therapy, neuropsychological testing, learning disability testing) |
Incompatible with Certain Populations | Statements questions the efficacy of telepsychology for a specifically named populations (e.g., young children, older adults, inmates) |
Unsupportive Prescription Regulations | Statements endorsing difficulty navigating prescriptive regulations or stating the prescription regulations are too burdensome |
Miscellaneous | Any statements that did not fit in a previously listed category |
Facilitators | |
Better Patient Access to Care | Statements regarding how telepsychology allows providers to assist patients who would otherwise not be able to be seen |
Lower Cost for Patient or Provider | Statements regarding reduced cost for the patient or provider or increased revenue for the provider |
Telepsychology Training I Have Received | Statements in which the provider endorsed comfortability with telepsychology as a specific result of having been trained in telepsychology services |
Better Therapeutic Alliance | Statements regarding how telepsychology positively effects the therapeutic alliance |
Efficient Use of Time | Statements regarding how telepsychology saves either the patient or provider time |
Improved Quality of Delivered Care or Effectiveness | Statements indicating better quality or more effective care using telepsychology and statements regarding the growth of research on the efficacy of telepsychology |
Leadership Support for Telepsychology | Statements indicating a provider’s employer supports the use of telepsychology |
Ethics | Statements indicating that telepsychology is ethically appropriate or imperative |
Supportive Laws or Health Insurance Portability and Accountability Regulations | Statements indicating generally positive or supportive laws and HIPAA regulations for telepsychology use |
Patient Demand for Telepsychology | Statements indicating a patient’s preference for telepsychology |
Provider Preference for Telepsychology | Statements indicating a provider’s preference for telepsychology |
Increased Safety for Patient or Provider | Statements indicating an increase in patient or provider safety as a direct result of telepsychology |
Adequate Technology for Telepsychology Use | Statements regarding that the technological requirements for telepsychology are currently adequate |
Supportive Prescription Regulations | Statements indicating the supportive nature of prescription regulations |
Miscellaneous | Any statements that did not fit in a previously listed category |
Barrier | Percentage |
---|---|
Frequently Endorsed (above 20%) | |
Inadequate Access to Technology | 62.5 |
Diminished Therapeutic Alliance | 53.3 |
Technological Issues | 49.2 |
Diminished Quality of Delivered Care or Effectiveness | 43.8 |
Privacy Concerns | 42.5 |
Inadequate Reimbursement | 37.5 |
Legal and Health Insurance Portability and Accountability Concerns | 30.2 |
Insufficient Telepsychology Training | 23.9 |
Ethical Concerns | 20.4 |
Safety Concerns | 20.2 |
Moderately Endorsed (10–20%) | |
Lack of Patient Demand | 18.6 |
Higher Cost for Patient or Provider | 10.3 |
Infrequently Endorsed (below 10%) | |
Inefficient Use of Time | 6.3 |
Lack of Leadership Support for Telepsychology | 4.6 |
Incompatible with Certain Services | 4.0 |
Unsupportive Prescription Regulations | 2.0 |
Incompatible with Certain Populations | 1.9 |
Miscellaneous | 0.5 |
Provider Dislike of Telepsychology | 0.2 |
Facilitator | Percentage |
Frequently Endorsed (above 20%) | |
Increased Safety | 84.5 |
Better Access to Patient Care | 79.3 |
Patient Demand | 64.5 |
Efficient Use of Time | 56.3 |
Adequate Technology for Telepsychology Use | 42.0 |
Supportive Laws and Health Insurance Portability and Accountability Regulations | 32.8 |
Lower Cost for Patient or Provider | 32.0 |
Improved Quality of Delivered Care or Effectiveness | 24.6 |
Moderately Endorsed (10–20%) | |
Telepsychology Training I Have Received | 18.7 |
Ethics | 13.7 |
Leadership Support for Telepsychology | 10.1 |
Infrequently Endorsed (below 10%) | |
Better Therapeutic Alliance | 4.0 |
Miscellaneous | 0.7 |
Provider Preference for Telepsychology | 0.0 |
Supportive Prescription Regulations | 0.0 |
95% CI for Exp(B) | |||||||
---|---|---|---|---|---|---|---|
Predictor | β | SE | Wald | p | Exp(B) | Lower | Upper |
Inadequate Access to Technology | |||||||
Age | 0.002 | 0.004 | 0.340 | 0.560 | 1.002 | 0.995 | 1.010 |
Cisgender Woman | 0.029 | 0.088 | 0.111 | 0.739 | 1.030 | 0.866 | 1.225 |
White | −0.121 | 0.146 | 0.681 | 0.409 | 0.886 | 0.666 | 1.180 |
Rural | 0.660 | 0.157 | 17.686 | 0.000 | 1.935 | 1.423 | 2.632 |
Medical Center | 0.959 | 0.183 | 27.463 | 0.000 | 2.610 | 1.823 | 3.737 |
CBT | 0.335 | 0.089 | 14.058 | 0.000 | 1.398 | 1.173 | 1.666 |
Diminished Therapeutic Alliance | |||||||
Age | −0.005 | 0.004 | 2.184 | 0.139 | 0.995 | 0.987 | 1.002 |
Cisgender Woman | −0.228 | 0.085 | 7.115 | 0.008 | 0.796 | 0.674 | 0.941 |
White | 0.121 | 0.139 | 0.766 | 0.381 | 1.129 | 0.860 | 1.481 |
Rural | 0.155 | 0.138 | 1.261 | 0.261 | 1.167 | 0.891 | 1.529 |
Medical Center | −0.515 | 0.149 | 11.929 | 0.001 | 0.598 | 0.446 | 0.800 |
CBT | −0.126 | 0.088 | 2.049 | 0.152 | 0.882 | 0.743 | 1.047 |
Technological Issues | |||||||
Age | −0.014 | 0.004 | 15.263 | 0.000 | 0.986 | 0.979 | 0.993 |
Cisgender Woman | 0.244 | 0.085 | 8.212 | 0.004 | 1.276 | 1.080 | 1.507 |
White | 0.157 | 0.139 | 1.284 | 0.257 | 1.171 | 0.891 | 1.537 |
Rural | 0.085 | 0.137 | 0.385 | 0.535 | 1.089 | 0.833 | 1.423 |
Medical Center | 0.113 | 0.148 | 0.578 | 0.447 | 1.119 | 0.837 | 1.496 |
CBT | 0.014 | 0.088 | 0.026 | 0.872 | 1.014 | 0.854 | 1.204 |
Diminished Quality of Delivered Care or Effectiveness | |||||||
Age | −0.008 | 0.004 | 5.043 | 0.025 | 0.992 | 0.985 | 0.999 |
Cisgender Woman | −0.294 | 0.086 | 11.847 | 0.001 | 0.745 | 0.630 | 0.881 |
White | 0.273 | 0.143 | 3.677 | 0.055 | 1.314 | 0.994 | 1.738 |
Rural | 0.032 | 0.138 | 0.055 | 0.815 | 1.033 | 0.789 | 1.352 |
Medical Center | −0.153 | 0.150 | 1.036 | 0.309 | 0.858 | 0.639 | 1.152 |
CBT | −0.360 | 0.088 | 16.794 | 0.000 | 0.698 | 0.588 | 0.829 |
Privacy Concerns | |||||||
Age | −0.012 | 0.004 | 10.937 | 0.001 | 0.988 | 0.981 | 0.995 |
Cisgender Woman | 0.252 | 0.087 | 8.486 | 0.004 | 1.287 | 1.086 | 1.525 |
White | −0.027 | 0.140 | 0.037 | 0.847 | 0.973 | 0.740 | 1.280 |
Rural | 0.134 | 0.138 | 0.944 | 0.331 | 1.143 | 0.873 | 1.497 |
Medical Center | −0.601 | 0.158 | 14.465 | 0.000 | 0.548 | 0.402 | 0.747 |
CBT | 0.061 | 0.089 | 0.465 | 0.495 | 1.062 | 0.893 | 1.264 |
Inadequate Reimbursement | |||||||
Age | −0.007 | 0.004 | 3.899 | 0.048 | 0.993 | 0.985 | 1.000 |
Cisgender Woman | 0.168 | 0.088 | 3.599 | 0.058 | 1.183 | 0.994 | 1.406 |
White | 0.091 | 0.144 | 0.398 | 0.528 | 1.095 | 0.826 | 1.451 |
Rural | 0.118 | 0.139 | 0.716 | 0.397 | 1.125 | 0.856 | 1.479 |
Medical Center | 0.148 | 0.149 | 0.979 | 0.322 | 1.159 | 0.865 | 1.553 |
CBT | 0.336 | 0.092 | 13.236 | 0.000 | 1.399 | 1.168 | 1.676 |
Legal and HIPAA Concerns | |||||||
Age | −0.006 | 0.004 | 2.514 | 0.113 | 0.994 | 0.986 | 1.001 |
Cisgender Woman | −0.189 | 0.092 | 4.247 | 0.039 | 0.828 | 0.691 | 0.991 |
White | −0.264 | 0.145 | 3.318 | 0.069 | 0.768 | 0.578 | 1.020 |
Rural | −0.011 | 0.148 | 0.006 | 0.939 | 0.989 | 0.740 | 1.321 |
Medical Center | 0.050 | 0.158 | 0.100 | 0.752 | 1.051 | 0.771 | 1.432 |
CBT | 0.149 | 0.096 | 2.389 | 0.122 | 1.161 | 0.961 | 1.402 |
Insufficient Telepsychology Training | |||||||
Age | −0.011 | 0.004 | 7.018 | 0.008 | 0.989 | 0.981 | 0.997 |
Cisgender Woman | −0.190 | 0.099 | 3.687 | 0.055 | 0.827 | 0.682 | 1.004 |
White | −0.206 | 0.155 | 1.775 | 0.183 | 0.814 | 0.601 | 1.102 |
Rural | 0.264 | 0.151 | 3.050 | 0.081 | 1.303 | 0.968 | 1.753 |
Medical Center | −0.004 | 0.171 | 0.001 | 0.980 | 0.996 | 0.713 | 1.391 |
CBT | 0.024 | 0.103 | 0.053 | 0.819 | 1.024 | 0.837 | 1.253 |
Ethical Concerns | |||||||
Age | −0.019 | 0.005 | 17.830 | 0.000 | 0.981 | 0.972 | 0.990 |
Cisgender Woman | −0.084 | 0.106 | 0.623 | 0.430 | 0.920 | 0.748 | 1.132 |
White | −0.202 | 0.162 | 1.552 | 0.213 | 0.817 | 0.595 | 1.123 |
Rural | 0.423 | 0.155 | 7.415 | 0.006 | 1.527 | 1.126 | 2.070 |
Medical Center | −0.124 | 0.184 | 0.452 | 0.501 | 0.883 | 0.616 | 1.268 |
CBT | −0.017 | 0.109 | 0.025 | 0.875 | 0.983 | 0.793 | 1.218 |
Safety Concerns | |||||||
Age | −0.014 | 0.005 | 9.765 | 0.002 | 0.986 | 0.977 | 0.995 |
Cisgender Woman | 0.086 | 0.107 | 0.640 | 0.424 | 1.089 | 0.883 | 1.344 |
White | 0.103 | 0.174 | 0.349 | 0.555 | 1.108 | 0.788 | 1.558 |
Rural | 0.225 | 0.162 | 1.938 | 0.164 | 1.253 | 0.912 | 1.721 |
Medical Center | 0.094 | 0.176 | 0.284 | 0.594 | 1.098 | 0.778 | 1.551 |
CBT | −0.037 | 0.109 | 0.113 | 0.736 | 0.964 | 0.778 | 1.194 |
95% CI for Exp(B) | |||||||
---|---|---|---|---|---|---|---|
Predictor | β | SE | Wald | p | Exp(B) | Lower | Upper |
Increased Safety | |||||||
Age | −0.004 | 0.005 | 0.692 | 0.405 | 0.996 | 0.986 | 1.006 |
Cisgender Woman | 0.595 | 0.113 | 27.570 | 0.000 | 1.813 | 1.452 | 2.265 |
White | 0.315 | 0.180 | 3.067 | 0.080 | 1.370 | 0.963 | 1.948 |
Rural | −0.033 | 0.184 | 0.032 | 0.858 | 0.968 | 0.675 | 1.388 |
Medical Center | 0.123 | 0.214 | 0.329 | 0.567 | 1.131 | 0.743 | 1.721 |
CBT | −0.015 | 0.121 | 0.015 | 0.901 | 0.985 | 0.778 | 1.248 |
Better Access to Patient Care | |||||||
Age | −0.011 | 0.005 | 6.303 | 0.012 | 0.989 | 0.980 | 0.997 |
Cisgender Woman | 0.049 | 0.104 | 0.224 | 0.636 | 1.051 | 0.856 | 1.289 |
White | 0.003 | 0.175 | 0.000 | 0.986 | 1.003 | 0.712 | 1.413 |
Rural | 0.144 | 0.176 | 0.673 | 0.412 | 1.155 | 0.818 | 1.632 |
Medical Center | 0.875 | 0.248 | 12.456 | 0.000 | 2.399 | 1.476 | 3.900 |
CBT | 0.461 | 0.103 | 20.107 | 0.000 | 1.586 | 1.297 | 1.941 |
Patient Demand | |||||||
Age | −0.016 | 0.004 | 16.194 | 0.000 | 0.984 | 0.977 | 0.992 |
Cisgender Woman | 0.145 | 0.088 | 2.707 | 0.100 | 1.156 | 0.973 | 1.375 |
White | 0.377 | 0.142 | 7.032 | 0.008 | 1.458 | 1.103 | 1.927 |
Rural | −0.276 | 0.140 | 3.897 | 0.048 | 0.759 | 0.577 | 0.998 |
Medical Center | 0.170 | 0.162 | 1.101 | 0.294 | 1.186 | 0.863 | 1.629 |
CBT | 0.374 | 0.090 | 17.348 | 0.000 | 1.454 | 1.219 | 1.734 |
Efficient Use of Time | |||||||
Age | −0.003 | 0.004 | 0.881 | 0.348 | 0.997 | 0.989 | 1.004 |
Cisgender Woman | −0.042 | 0.086 | 0.237 | 0.626 | 0.959 | 0.811 | 1.134 |
White | −0.441 | 0.145 | 9.183 | 0.002 | 0.644 | 0.484 | 0.856 |
Rural | 0.018 | 0.138 | 0.018 | 0.895 | 1.018 | 0.778 | 1.334 |
Medical Center | 0.174 | 0.151 | 1.335 | 0.248 | 1.190 | 0.886 | 1.600 |
CBT | 0.244 | 0.088 | 7.793 | 0.005 | 1.277 | 1.076 | 1.516 |
Adequate Technology for Telepsychology Use | |||||||
Age | 0.006 | 0.004 | 2.236 | 0.135 | 1.006 | 0.998 | 1.013 |
Cisgender Woman | 0.073 | 0.086 | 0.732 | 0.392 | 1.076 | 0.910 | 1.273 |
White | −0.164 | 0.139 | 1.398 | 0.237 | 0.849 | 0.646 | 1.114 |
Rural | −0.095 | 0.139 | 0.473 | 0.491 | 0.909 | 0.693 | 1.193 |
Medical Center | 0.216 | 0.148 | 2.134 | 0.144 | 1.240 | 0.929 | 1.656 |
CBT | 0.126 | 0.089 | 2.022 | 0.155 | 1.134 | 0.953 | 1.349 |
Supportive Laws and HIPAA Regulations | |||||||
Age | −0.001 | 0.004 | 0.092 | 0.762 | 0.999 | 0.991 | 1.006 |
Cisgender Woman | 0.253 | 0.091 | 7.672 | 0.006 | 1.288 | 1.077 | 1.541 |
White | 0.046 | 0.148 | 0.099 | 0.753 | 1.048 | 0.784 | 1.399 |
Rural | 0.182 | 0.142 | 1.643 | 0.200 | 1.200 | 0.908 | 1.586 |
Medical Center | −0.485 | 0.170 | 8.140 | 0.004 | 0.615 | 0.441 | 0.859 |
CBT | 0.130 | 0.094 | 1.928 | 0.165 | 1.139 | 0.948 | 1.369 |
Lower Cost for Patient or Provider | |||||||
Age | 0.007 | 0.004 | 3.037 | 0.081 | 1.007 | 0.999 | 1.015 |
Cisgender Woman | −0.172 | 0.090 | 3.617 | 0.057 | 0.842 | 0.705 | 1.005 |
White | −0.413 | 0.143 | 8.398 | 0.004 | 0.662 | 0.500 | 0.875 |
Rural | −0.114 | 0.148 | 0.592 | 0.442 | 0.892 | 0.667 | 1.193 |
Medical Center | 0.457 | 0.151 | 9.185 | 0.002 | 1.579 | 1.175 | 2.122 |
CBT | 0.273 | 0.096 | 8.124 | 0.004 | 1.314 | 1.089 | 1.586 |
Improved Quality of Delivered Care or Effectiveness | |||||||
Age | 0.006 | 0.004 | 1.990 | 0.158 | 1.006 | 0.998 | 1.014 |
Cisgender Woman | 0.208 | 0.100 | 4.360 | 0.037 | 1.231 | 1.013 | 1.496 |
White | −0.212 | 0.154 | 1.896 | 0.169 | 0.809 | 0.598 | 1.094 |
Rural | 0.148 | 0.154 | 0.931 | 0.335 | 1.160 | 0.858 | 1.567 |
Medical Center | 0.020 | 0.170 | 0.014 | 0.906 | 1.020 | 0.731 | 1.425 |
CBT | 0.154 | 0.103 | 2.253 | 0.133 | 1.167 | 0.954 | 1.427 |
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Share and Cite
Watson, J.D.; Pierce, B.S.; Tyler, C.M.; Donovan, E.K.; Merced, K.; Mallon, M.; Autler, A.; Perrin, P.B. Barriers and Facilitators to Psychologists’ Telepsychology Uptake during the Beginning of the COVID-19 Pandemic. Int. J. Environ. Res. Public Health 2023, 20, 5467. https://doi.org/10.3390/ijerph20085467
Watson JD, Pierce BS, Tyler CM, Donovan EK, Merced K, Mallon M, Autler A, Perrin PB. Barriers and Facilitators to Psychologists’ Telepsychology Uptake during the Beginning of the COVID-19 Pandemic. International Journal of Environmental Research and Public Health. 2023; 20(8):5467. https://doi.org/10.3390/ijerph20085467
Chicago/Turabian StyleWatson, Jack D., Bradford S. Pierce, Carmen M. Tyler, Emily K. Donovan, Kritzia Merced, Margaret Mallon, Aaron Autler, and Paul B. Perrin. 2023. "Barriers and Facilitators to Psychologists’ Telepsychology Uptake during the Beginning of the COVID-19 Pandemic" International Journal of Environmental Research and Public Health 20, no. 8: 5467. https://doi.org/10.3390/ijerph20085467