Patients facing care access barriers but no technology limitations are more likely to opt for a telehealth visit with their providers, compared to those with limited access barriers or challenges with technology, according to new data published in JAMA Network Open.
This data, while collected prior to the COVID-19 pandemic, could have implications for healthcare organizations leaning on telehealth to expand patient access to care while cutting the risk for COVID spread in the office.
Even before the outbreak of the novel coronavirus, telehealth presented key opportunities for patient care access. The technology allowed patients to visit with their medical providers without having to travel into the clinic, posing a serious convenience factor that could boost patient engagement and satisfaction.
But telehealth access does not come without its challenges. The technology relies on strong broadband and internet signal, something of a threat in rural areas or for families in low-income neighborhoods where access is typically limited.
Want to publish your own articles on DistilINFO Publications?
Send us an email, we will get in touch with you.
Telehealth may also be off-putting for some patients who are reticent to use technology. Many medical providers have questioned whether older adult patients would be receptive to telehealth visits as opposed to in-person visits.
This latest data, gathered by experts at Kaiser Permanente, Emory University, and the University of California Berkeley, looked at the specific patient characteristics that pushed an individual patient to choose telehealth over in-person care, or vice versa.
Looking at data for 1,131,722 patients who had scheduled an appointment using the Kaiser Permanente of Northern California patient portal, the researchers sought to determine what would make a patient choose either telehealth or in-person care.
The team looked at the appointment delivery type as well as key patient demographics like age, sex, race or ethnicity, neighborhood socioeconomic status, or language preference. The team also looked at technology access, meaning whether the patient had the hardware and internet connection needed to conduct telehealth, whether the patient would be visiting a clinician she already knew, and barriers to in-person care access.
Overall, 86 percent of patient cases happened in person, while 14 percent were conducted using telehealth. Of those telehealth visits, half were done using video visit technology and the other using a phone call.
There were considerable connections between choosing an in-person care visit. Patients over age 65, for example, were more likely to want to visit their provider in the office compared to patients ages 18 to 44.
Meanwhile, access to technology and other traditional care access barriers increased the odds a patient might opt for telehealth access. Patients who had reliable internet access — as determined by looking at the residential neighborhood in which the patient lived — were more likely than those in low internet access areas to opt for telehealth.
Certain care access barriers, like having a paid parking structure at a facility as opposed to free parking, also made it more likely the patient might want to use telehealth.
“Further, there appears to be nuance in choice between phone and video visit types,” the researchers reported.
Black patients were more likely than white patients to choose a video-based virtual visit. Asian patients were more likely than white patients to pick a video visit, but less likely to choose a telephone visit. The researchers did not have an explanation for these differences.
Further, socioeconomic status played a role in the type of telehealth — video visit or asynchronous — a patient selected.
“Patients living in lower socioeconomic status neighborhoods were more likely to choose a telephone visit but were less likely to choose a video visit than patients in higher socioeconomic status neighborhoods,” the researchers said.
“Because mobile devices are used in most video visits, and are increasingly the primary internet-access in vulnerable groups or those with lower health-engagement, mobile-friendly tools may represent valuable opportunities to engage these patients.”
Patient financial responsibility also had a role to play. Patients who had high cost-sharing for their medical visits were more likely to opt for telehealth, even if there were still out-of-pocket costs associated with a telehealth visit. The option for telehealth made no difference for patients considering not to access care at all due to costs.
The researchers gathered this data between 2016 and 2018, long before the coronavirus surged through the nation and sparked an unprecedented movement toward telehealth. However, it can still provide some insights for healthcare organizations beginning to reopen their doors to in-person care, while balancing some treatment with telehealth access.
Notably, the data can help target patients who otherwise may not have been interested in telehealth treatment either because of technology concerns or other issues. For example, noting that a patient lives in a neighborhood with limited internet access but who otherwise is a great candidate for telehealth care could spark an intervention to facilitate that telehealth care.
Nonetheless, it will be key for medical professionals to remember that these patient sentiments may have changed with the pandemic. Most data confirms that patients are okay with receiving their care via telehealth, and expect to continue doing so as the nation begins its recovery phases.
Source: PatientEngagement HIT