Willingness to Engage in Video Visits Spikes, Especially Among Black Americans

During the COVID-19 pandemic, the willingness to participate in video-based telehealth grew among Americans, particularly Black Americans and US adults with less than a high school education, according to a new study.

Conducted by the nonprofit research organization RAND Corp., the study includes responses from 1,600 US adults who participated in the RAND American Life Panel. They completed surveys in February 2019, May 2020, August 2020, and March 2021. The surveys focused on their telehealth use and attitude toward the care modality.

The study published in Health Affairs shows that Americans' willingness to use video-based telehealth jumped from 51 percent in February 2019 to 62 percent in March 2021.

Further, among survey respondents, the proportion of people who reported having video visits increased to nearly 20 percent by August 2020 and 45 percent by March 2021.

"Our findings suggest that more Americans are becoming comfortable with telehealth and using video technology," said Shira H. Fischer, MD, PhD, study lead author and a physician scientist at RAND, in a press release. "This is important because there are concerns that lack of access to or willingness to use video telehealth may exacerbate disparities in the delivery of high-quality health care."

The sub-groups who reported the highest use of telehealth by March 2021 were Black adults (57 percent), adults between 20 and 39 years (52 percent), adults with less than a high school education (62 percent), and low-income adults (52 percent).

The study shows that willingness to participate in video-based telehealth visits increased most significantly among Black Americans and those with lower levels of education. Willingness spiked from 42 percent in February 2019 to 67 percent in March 2021 among Black adults.

Similarly, willingness to participate in video visits spiked from 30 percent to 56 percent in the same period among those with less than a high school education.

The rise in willingness is likely due to the in-person care restrictions brought about by the COVID-19 pandemic, according to the researchers. Additionally, the fact that providers they trusted offered video visits may have encouraged patient use of video-based telehealth.

Overall, respondents who used telehealth during the pandemic had 5.6 greater odds of becoming more willing to continue using it over time, the study shows.

But Americans older than 60 years, Hispanic adults, and those who reported a lack of experience with telehealth during the first year of the pandemic were all less likely to be willing to use telehealth in March 2021.

"This is not entirely surprising, given that our prior research has shown that most patients still report a preference for in-person care," the researchers wrote in the study. "With recent policy changes (for example, Medicare reimbursement for video and audio-only visits for behavioral health without originating site or geographic restrictions) carving out a permanent place for telehealth in care delivery, it will be important to address sources of unwarranted variation in patients' willingness to ensure equitable access."

The new research comes on the heels of another study showing that patient satisfaction with telehealth visits during the COVID-19 pandemic was on par with satisfaction with in-person care.

Published in the Patient Experience Journal, the study examined data from standardized patient experience surveys conducted between July 1, 2020, and June 30, 2021. The study shows that satisfaction levels between in-person and telehealth visits were similar across patient age groups, sex, race, ethnicity, and language during the study period.

But despite these positive associations, telehealth use has dropped since 2020, when virtual care utilization hit its peak. A recent report by Trilliant Health shows that telehealth visit volumes fell 37 percent from 73.7 million in the second quarter of 2020 to 46.4 million in the first quarter of 2022.