Audio-Only Telehealth Supported Care Delivery at FQHCs During Pandemic

When the COVID-19 pandemic began, many federally qualified health centers (FQHCs) abruptly switched to remote care methods, including audio-only care modalities, for non-urgent appointments, according to a new report.

Released by the RAND Corporation, the report assessed the progress of FQHCs that participated in the Connected Care Accelerator (CCA) program. The California Health Care Foundation established the CCA initiative to assist FQHCs with telehealth delivery, including evaluating how telehealth affected them during the pandemic, what was helpful, and what can be improved, as the sudden pivot to virtual care caused a strain on many FQHCs.

The RAND report focused on changes in telehealth utilization and FQHC staff experiences with implementation.

The report shows that audio and video visits increased during the pandemic despite the fact that the number of overall visits remained unchanged. Researchers also noted that behavioral health was the most common type of telehealth visit.

Audio-only visits were more popular than in-person care for both primary care and behavioral health services through most of the pandemic study period, that is, August 2020 to August 2021. By the end, audio-only visits were eclipsed by in-person visits for primary care, but not for behavioral health.

In the last three months of the study period, 30 percent of all visits occurred through an audio-only setting. During the same time period, 52 percent of appointments related to behavioral health services took place in an audio-only environment.

Researchers also noticed that patients who did not speak English as a primary language were less likely to use video services, which led to clinics taking steps to eliminate the digital divide, like adding onboarding processes that screened patients for technology access, providing information technology services if needed.

Overall, telehealth enabled FQHCs to provide a sufficient level of care and maintain a high level of patient engagement and accessibility.

But further research regarding the benefits and limitations of telehealth is necessary and more information regarding the effect of audio-only visits on care quality is needed, researchers stated.

In addition, researchers found that health centers need adequate time to compose and implement effective telehealth services. The beginning of the COVID-19 pandemic was associated with a high level of urgency. However, being prepared for the future is vital. Despite the continued use of telehealth, health centers must remain prepared to handle any situation in person.

Throughout the COVID-19 pandemic, research has backed up the popularity of telehealth.

In October 2020, J.D. power conducted the US Telehealth Satisfaction Study, which intended to reveal the positives and negatives of virtual care. On a 1,000-point scale, the overall patient satisfaction score was 860. This survey included 4,300 participants who used telehealth within the year prior. Despite this strong score, a few areas for improvement included technical difficulties, lack of clarity in pricing, and limited services.

Though the number of telehealth modalities is growing, physicians prefer live interactive audio-visual platforms, with 93 percent of physicians indicating that they use this modality in a recent survey. Audio-only phone-based telehealth is also popular, with 69 percent of respondents saying they used this technology for virtual care.

A previous study also concluded that older, Black patients are more likely to use audio-only telehealth. The study included an examination of patients from Ann Arbor-based Michigan Medicine, and researchers found that 63.8 percent of patients aged 71 to 75 years were most likely to engage in visits via telephone, the highest of any age group. Researchers also found that 53.6 percent of Black patients used phone-only visits.