Quality, ease of use and type of care are factors in choosing telehealth over in-person patient visits

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The study analyzes clinicians’ and patients’ preferences for primary care, mental health and specialty care.

According to a new study, clinicians’ beliefs about the quality and ease of use of telehealth play a role in how they use telehealth or in-person visits with patients.

Attitudes towards telehealth also vary by practice, with differing preferences among clinicians in primary care (PC), specialty care, and mental health.

The study, “Perceptions and use of telehealth among mental health, primary care, and specialty clinicians during the COVID-19 pandemic,” was published June 7 in the journal JAMA network open.

Researchers analyzed survey responses from 814 clinicians from the Department of Veterans Affairs New England Healthcare System (VANEHS), conducted from August to September 2021.

The pool included 403 mental health clinicians, 153 primary care clinicians and 258 specialty care clinicians who recorded 402,989 patient visits at eight medical centers serving approximately 260,000 veterans annually in six states. They were asked about:

  • Factors for choosing in-person, video or telephone visits
  • The challenges of telehealth
  • Care preferences for new and established patients

They found that mental health clinicians had the highest proportion of video visits during the survey period. They gave the highest ratings to the quality of video care and were more likely to prefer video over phone connections when providing remote patient care.

Primary care and specialist clinicians were more likely to rate telephone care as at least equivalent in quality to video. Either they had no preference, or they preferred telephone or remote care for established patients.

Specialists were more likely to rate video and telephone care as lower quality than in-person care when treating new patients, and they had the highest proportion of in-person visits of all clinician groups. They endorsed more challenges with telephone visits, including the inability to assess patients’ health status, compared to primary care clinicians.

Primary care by telephone

For established patients, primary care clinicians — 87 physicians, 33 nurse practitioners, 25 pharmacists and eight physician assistants in the study — had the highest proportion of phone visits. The researchers noted that video visits are more challenging than audio-only phone visits because both patients and clinicians need video devices, internet connectivity, and the ability to navigate a web-based platform. video telehealth.

The primary care finding “highlights the importance of complexity in influencing the adoption of new technologies; if PC clinicians believe phone and video care are of equal quality, then ease of use may lead to choosing phone over video, especially when treating patients they have already seen in person “says the study.

Across all specialties, clinicians endorsed patient preference as “a major contributor” to choosing in-person, video, or phone visits. It’s becoming increasingly clear that patients prefer video visits, but a large portion of remote visits are still done over the phone, the study found. The researchers noted differences between clinician preference, patient preference, and patient readiness for telehealth.

“A patient without a smartphone may be considered to prefer a telephone appointment because they do not have access to appropriate technology,” the study states. “Indeed, COVID-19 has revealed a marked digital divide in which older and/or low-income patients are less likely to be video-ready.”

The researchers note that the VANEHS financial model is a strength of the study because clinicians’ choices were not driven by fee-for-service, so the results “may better reflect clinicians’ intrinsic preferences.”

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