Telehealth Use During the COVID-19 Pandemic: A Case Study at Dialysis Centers in Washington, United States

Rationale & Objective: Telehealth has notably surged since the emergence of the coronavirus 2019 pandemic. In nephrology, it has become crucial in delivering care to patients treated with dialysis, especially after the removal of previous restrictions that limited its application in dialysis settings. The objective of this study is to examine the perceptions of telehealth held by patients treated with dialysis and nephrologists. Study Design: A qualitative case study. Setting & Participants: The case in this study is the telehealth utilization process for dialysis care within dialysis centers in Washington State, USA. Participants were patients treated with in-center hemodialysis and home dialysis and nephrologists who have experienced telehealth in dialysis care. Exposure: The use of telehealth. Outcomes: Perceptions, decision-making process, challenges, and the adaptation strategies employed when using telehealth in a dialysis setting. Analytical Approach: Data collection involved in-depth interviews with nephrologists and patients treated with dialysis, direct observation of telehealth usage during dialysis care, and analysis of documents from dialysis companies. Data analysis and interpretation were conducted through coding, categorization, and thematic analysis. Results: The participants included 12 patients treated with dialysis and 6 nephrologists from 2 dialysis centers. Six themes with subthemes emerged from the analysis, including telehealth acceptance (the ability to see more patients, comparison to in-person visits), telehealth rejection (the lack of personal connection and privacy, the indispensable role of nephrologists), the nephrologist's role in decision-making, challenges with telehealth connectivity affecting dialysis visits, the unsupportive role of dialysis companies, and adaptation to technological challenges. Limitations: Patients from only one dialysis center participated in this study. Conclusions: Telehealth shows potential to complement traditional dialysis care by enhancing accessibility and patient monitoring. More research is needed to assess the broader impact of telehealth on patient outcomes and health care efficiency in dialysis management. Plain-Language Summary: This study describes nephrologists’ and patients treated with dialysis’ perspectives on the use of telehealth for dialysis care during the COVID-19 pandemic. Data are from multiple sources, including in-depth interviews, direct observations, and document analysis. We identified 6 major themes, including telehealth acceptance, telehealth rejection, the nephrologist's role in decision-making, challenges with telehealth connectivity affecting dialysis visits, the unsupportive role of dialysis companies, and adaptation to technological challenges. These findings indicate that telehealth allows nephrologists to deliver care to medically stable patients treated with dialysis. However, its use introduces challenges for both nephrologists and patients, highlighting the need for assistance and adjustments from dialysis nurses and companies.