Video Telehealth Quality Largely on Par with In-Person Care

A sweeping review of research on telehealth shows that live video telehealth is as effective as in-person care in treating certain conditions, like mental health conditions, but there is a concerning lack of research on disparities in telehealth-enabled care.

Conducted by the California Health Benefits Review Program and the Philip R. Lee Institute for Health Policy Studies at the University of California San Francisco, the review includes studies published between January 2021 and October 2022. Researchers included 80 studies that examine the use of telehealth modalities as a substitute for in-person care in the analysis for the report.

The review includes research on live video, telephone-only, asynchronous communication via email, text, and chat, e-visits through two-way messages or a short questionnaire on a health portal, store and forward telehealth, and hybrid care.

The research reviewed shows that most modalities and services result in similar health outcomes compared with in-person care. Live video visits, in particular, have a preponderance of evidence showing they are on par with in-person care in terms of health outcomes, processes of care, and utilization of other healthcare services. In the report, the preponderance of evidence refers to the fact that “the majority of the studies reviewed are consistent in their findings that treatment is either effective or not effective.”

Other modalities, like telephone, asynchronous communication, and e-visits, have more limited evidence, while store and forward telehealth and hybrid care have inconclusive and insufficient evidence, respectively.

Inconclusive evidence indicates that although some studies find effectiveness, a similar number of studies of equal quality suggest a lack of effectiveness, while insufficient evidence indicates too few studies to determine whether or not a modality is effective or the available studies are not of high quality.

Telehealth modalities are more effective for certain specialties and conditions than others, the report shows.

For instance, there is clear and convincing evidence that live video telehealth is effective in treating orthopedic issues, chronic conditions, and behavioral health conditions, including depression and anxiety. However, there is insufficient evidence of its efficacy in surgical care, ophthalmology, and examinations for respiratory illnesses.

The other telehealth modalities had limited evidence in treating behavioral health, reproductive health, eating disorder management, and dermatology. The authors defined limited evidence as indicating that “the studies have limited generalizability to the population of interest, and/or the studies have a fatal flaw in research design or implementation.”

Further, live video telehealth had a preponderance of evidence suggesting that it resulted in the same amount of utilization of other healthcare services as in-person care for those needing urologic, infectious disease, diabetes, and postsurgical care.

However, the report also found gaps in research on telehealth disparities.

“It’s disappointing how little of this literature examines differences among patient demographic groups,” the authors wrote. “Few studies address the effectiveness of telehealth services for lower- versus higher-income people, older versus younger people, non-English speakers versus English speakers, and different racial and ethnic group.”

Additionally, there are research gaps pertaining to the impact of telephone-based care, hybrid care, and email, text, and chat on healthcare delivery processes and utilization of other care services.

Going into 2024, the scrutiny over telehealth’s efficacy and its impact on care delivery will intensify. Most pandemic-era telehealth policy flexibilities that spurred the unprecedented adoption and use of telehealth are set to expire at the end of 2024. This includes Medicare waivers that allow patients to participate in telehealth visits from their homes and coverage of audio-only visits, as well as rules around the virtual prescribing of controlled substances.

Americans are firmly in favor of extending telehealth flexibilities. In a survey conducted by America's Health Insurance Plans (AHIP) in 2022, 82 percent of 818 American adults said the federal government extending telehealth flexibilities is important.