BackgroundTelehealth has the potential to increase access to care for medically underserved patients. This qualitative study aimed to identify telecare practices used during the COVID-19 pandemic to meet the needs of patients experiencing homelessness, patients with disabilities, and patients with language preference other than English (LOE).MethodsWe conducted a secondary qualitative data analysis of 47 clinician interviews at Federally Qualified Health Centers (FQHCs) around the country. Using thematic analysis, transcripts were coded by line-by-line by five qualitative researchers. A multidisciplinary team of telehealth experts, researchers and primary care clinicians reviewed memos and excerpts to generate major themes.ResultsWe identified six main areas demonstrating how community providers developed strategies or practices to improve access to care for vulnerable patients: reaching patients experiencing homelessness, serving deaf and hard of hearing patients, improving access for patients with disabilities, serving patients with LOE, improving access for mental and behavioral health services, and educating patients about telehealth. During the pandemic, FQHCs developed innovative solutions to provide access to care for the unhoused, including using telehealth in shelters, vans, and distributing devices like mobile phones and tablets. Telehealth reduced transportation burdens for patients with disabilities and reduced no-show rates for mental health services by adapting group therapy via telehealth features (like break-out rooms) and increasing provider capacity.ConclusionOur study identified strategies adopted by FQHCs to serve underserved populations during the COVID-19 pandemic. Our findings highlight the need for enduring strategies to improve health equity through telehealth..

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调整远程医疗以解决健康公平问题：美国各地初级保健提供者的观点

背景远程医疗有可能增加医疗服务不足的患者获得护理的机会。这项定性研究旨在确定在 COVID-19 大流行期间使用的远程护理实践，以满足无家可归患者、残疾患者和英语以外语言偏好 (LOE) 的患者的需求。方法我们对 47 名临床医生进行了二次定性数据分析在全国各地的联邦合格健康中心 (FQHC) 进行面谈。使用主题分析，五位定性研究人员逐行对文字记录进行编码。由远程医疗专家、研究人员和初级保健临床医生组成的多学科团队审查了备忘录和摘录，以产生主要主题。结果我们确定了六个主要领域，展示了社区提供者如何制定策略或实践来改善弱势患者获得护理的机会：接触无家可归的患者、为聋人服务和听力障碍患者，改善残疾患者的就医机会，为 LOE 患者提供服务，改善心理和行为健康服务的可及性，并对患者进行远程医疗教育。疫情期间，FQHC 开发了创新解决方案，为无家可归者提供护理服务，包括在避难所、货车中使用远程医疗，以及分发手机和平板电脑等设备。远程医疗通过远程医疗功能（如分组讨论室）调整团体治疗并提高提供者的能力，减轻了残疾患者的交通负担，并降低了心理健康服务的缺席率。结论我们的研究确定了 FQHC 为服务欠缺人群而采取的策略2019冠状病毒病大流行。我们的研究结果强调需要采取持久战略，通过远程医疗改善健康公平。