Female, chronically ill patients more likely to use telehealth

A significant proportion of patients continued to choose telehealth even when in-person care was widely available in 2022, with female and chronic care patients being the most likely to select virtual care, according to new research.  

Following the onset of the COVID-19 pandemic in 2020, telehealth adoption and use skyrocketed. This was mainly due to restrictions placed on in-person care to prevent the spread of the novel coronavirus. In-person care resumed in 2021 and 2022, following which telehealth use leveled out. Still, telehealth usage has remained higher than pre-pandemic levels.

Thus, researchers from Advocate Health, Kaiser Permanente Washington Health Research Institute, and RTI International set out to investigate telehealth use and the patient characteristics associated with this use in 2022. They published their findings in JAMA Network Open.

The researchers conducted a cross-sectional study using data from the 2022 Health Information National Trends Survey (HINTS), a nationally representative self-reported survey of United States adults administered by the National Cancer Institute. They gathered data on 5,437 patients who had a healthcare visit via video, audio-only, or in-person in the past 12 months.

Of the 5,437 patients included in the study, 2,384 patients (43 percent) reported participating in one or more visits through telehealth.

In multivariable analysis, researchers found that having chronic conditions, seeking multiple healthcare visits, and being female significantly increased the odds of having any telehealth visits. Conversely, being 75 or older, having no internet access, and living in the Midwest lowered the likelihood of telehealth visits.

Most patients who participated in telehealth visits had a video visit (70 percent), while the rest (30 percent) had an audio-only visit.

Researchers observed that being 65 to 74, uninsured, and not having internet access were significantly associated with greater odds of audio-only telehealth visits versus video-based telehealth. There were no significant differences in telehealth use or telehealth modality by education, race and ethnicity, or income.

Most patients who participated in video-based telehealth (76 percent) and audio-only telehealth (67 percent) did so based on clinician recommendation or requirement. About 68 percent of video-based and 60 percent of audio-only telehealth participants selected virtual care options due to convenience.

Approximately 30 percent of patients using either telehealth modality sought acute care, while 22 percent sought chronic disease management services. Further, patients who used audio-only telehealth were more likely than video-visit patients to use telehealth for an annual visit, while patients using video-based telehealth were more likely than audio-only telehealth patients to use it for behavioral healthcare. Only 2 percent of patients used telehealth for medical emergencies.

However, researchers noted that patient satisfaction with telehealth could be waning. A quarter (25 percent) of both video-visit and audio-only patients said that virtual care was not as good as in-person care, while 19 percent reported experiencing technical problems.

Still, researchers concluded that the steady use of telehealth by over two-fifths of adult patients in 2022, especially those with chronic care needs, suggests that “telemedicine could endure as a satisfactory option in health care delivery.”

“We did not observe differences in telemedicine use or mode by several common measures of socioeconomic status (eg, race and ethnicity, education, income), which may reflect the widespread use of electronic devices and successful national and health care system efforts to maximize telemedicine adoption,” they wrote. “However, access to telemedicine, and video visits more specifically, is still less likely among key portions of the population who experience other logistical barriers to accessing care.”

The research comes amid ongoing conversations about telehealth access among lawmakers.

Calls to make pandemic-era flexibilities permanent are intensifying, with hundreds of virtual care stakeholders urging Congress to take action on telehealth regulations well before waivers expire on December 31, 2024.

In a letter submitted to Congressional leaders in February, more than 200 trade associations, healthcare provider organizations, and digital health companies stated that “telehealth flexibilities have played a critical role in promoting access to vital health care,” especially for underserved communities.

They further noted that solidifying telehealth flexibilities earlier in the year “will provide much needed certainty, and safeguard against this important policy getting left behind among competing priorities at the end of the year.”