Mental Health Providers’ Comfort in Prescribing Over Telemedicine: Content Analysis of Challenges and Solutions (Preprint)

BACKGROUND In response to the COVID-19 pandemic, the U.S. extended regulatory flexibilities to make telemedicine more accessible to providers and patients. Some of these flexibilities allowed providers to in-take patients over telemedicine and prescribe certain scheduled medications without an in-person visit. OBJECTIVE We aim to understand providers’ parameters for their comfort in prescribing over telemedicine and report on solutions providers have adopted in answer to potential barriers and challenges in prescribing via telemedicine. METHODS As part of a larger mixed-method study between February and April 2024, we conducted 16 semi-structured interviews with mental health providers who prescribe via telemedicine. We used the results of a web-based, cross-sectional survey to develop a codebook and support recruitment. We analyzed a subsection of the 16 interviews using content analysis to capture comfort, barriers, and workarounds in telemedicine prescribing. We reported codes by frequency and by provider. RESULTS Participants were typically male (11/16), provided care mostly or completely over telemedicine (11/16), and were psychiatrists (8/16) or other physician (3/16). The content analysis yielded a total of 234 codes with three main codes–comfort (n=98), barriers or challenges (n=85), and workarounds or solutions (n=27)–and two subcodes–uncomfortable prescribing (n=30) and comfortable prescribing (n=68) over telemedicine. Participants reported being comfortable prescribing over telemedicine as long as they could meet their main parameters of working within their expertise, having access to needed patient health information, and being compliant with rules and regulations. Participants reported frustrations with e-prescription workflows and miscommunications with pharmacies. Solutions to ease frustrations and alleviate discomforts in prescribing over telemedicine included developing workflows to help patients complete labs and physical exams and directly communicating with pharmacies. CONCLUSIONS By applying content analysis to the semi-structured provider interviews, we found that physicians are comfortable prescribing via telemedicine when they feel they are practicing within their personal parameters for safety. While many providers experience frustrations such as miscommunication with pharmacies, these barriers do not prevent them from telemedicine prescribing. With expected changes in 2024 to the U.S. laws and regulations for telemedicine prescribing, we may see changes in provider comfort in prescribing.