Most Physicians Find Video Telehealth Quality Inferior to In-Person Care

More than half of physicians surveyed (60 percent) felt that the quality of video-based telehealth was generally inferior to the quality of in-person care, according to a recent study.

The study, conducted by researchers from Harvard University, Washington University in St. Louis, and the Centers for Disease Control and Prevention, among other organizations, was published in the April 2023 issue of Health Affairs.

The researchers aimed to examine overall perceptions of video-based telehealth, particularly perceptions of video telehealth care quality compared to in-person care. They conducted two nationally representative surveys: one among primary care physicians who conducted video visits during the COVID-19 pandemic and another among patients who had a video visit with a primary care physician.

The physician survey was conducted from Feb. 12 to May 24, 2021, while the patient survey was conducted from April 30 to May 11, 2021. Responses from 337 primary care physicians were included in the analysis of the first survey. Around 6,650 patients completed the second survey, of whom 1,417 had a video visit.

Providers and patients had positive associations with video-based telehealth overall. Nearly all physicians (90 percent) and patients (90 percent) said their video visits during the pandemic went well.

Further, 86 percent of physicians felt that video visits were an important tool to reach patients, and 50 percent of patients reported that they would have delayed care or not seen a doctor without access to video visits.

But perceptions of video telehealth quality varied among physicians and patients. About 60 percent of physicians stated that video visit care quality was worse than what they could provide in person during the pandemic, while 29 percent said that it was equivalent.

About a third (33 percent) of patients reported that the quality of their video visit was worse than in-person care, and 51 percent said that it was equivalent.

A vast majority of physicians (92 percent) and patients (90 percent) cited challenges related to conducting physical exams as the reason they believed the quality of video-based telehealth was inferior to in-person care. The second most frequently cited reason was difficulties in getting vital signs.

Not only that, but nearly half of the physicians (45 percent) said that creating rapport was harder during video visits than in person. However, 58 percent of patients reported feeling as comfortable talking to a doctor on video as they felt in person.

Looking ahead, only a fifth of physicians said they would prefer to conduct most visits by video or audio, while 80 percent said they preferred providing in-person care.

Approximately 36 percent of patients said they would prefer to receive care for the same issue via video or audio after the pandemic. In contrast, 64 percent wanted to return to in-person visits.

Adjusted analyses revealed that physicians who experienced major technological challenges were more likely to want to return to in-person patient visits than those who experienced no difficulties. But other obstacles to video-based telehealth, such as perceived lack of quality and difficulty building a rapport with patients, did not significantly influence physicians' likelihood of returning to in-person care.

On the other hand, patients who felt that video visit quality was worse than in-person care or that video visits did not enable good rapport with physicians were more likely to prefer returning to in-person care after the pandemic compared with those who thought that video-based and in-person care were equivalent.

Researchers also found that patients who were older, with lower educational attainment, and were Asian were more likely to prefer in-person care after the pandemic compared with their counterparts.

These survey findings align with prior research on video-based telehealth use.

A report released last year by the Assistant Secretary for Planning and Evaluation shows that video telehealth visits were higher among those between 18 and 24 years (72.5 percent), college graduates (67.4 percent), and those with private health insurance (65.9 percent) as compared to their peers.

But video telehealth visits were less likely among Latino (50.7 percent), Asian (51.3 percent), and Black respondents (53.6 percent) than White respondents (61.9 percent).