Older, Black Patients More Likely to Use Audio-Only Telehealth

Patients in older age groups and those who are Black are more likely to use audio-only telehealth as compared with video-based care, according to a new study.

As telehealth flexibilities that were enacted due to the COVID-19 pandemic come to an end, states must decide which ones to make permanent. A key consideration for state policymakers will be the type of telehealth modality that will be most needed by residents — audio-only or video-based.

The study, which was published in the Journal of General Internal Medicine, shows that there are different demographic characteristics associated with telehealth use.

For the study, researchers examined data for all patients at Ann Arbor-based Michigan Medicine who had an outpatient visit that was eligible for telehealth from April 1, 2020, through June 30, 2020.

Overall, researchers studied 148,997 unique patients who had 266,350 outpatient visits at Michigan Medicine during the study period. Of these, 44,793 patients (30.1 percent) had only in-person visits and 104,204 patients (69.9 percent) had at least one telehealth visit.

Of all telehealth users, 45.4 percent received care via the telephone, while 54.6 percent completed at least one video visit.

Older age was associated with lower use of video visits compared to phone visits. In total, 46.1 percent of patients aged 51 to 55 years relied on phone visits compared to 54.3 percent of patients aged 61 to 65 years and 63.8 percent of patients aged 71 to 75 years.

Race was also a key characteristic that indicated the likelihood of phone visits. About 53.6 percent of self-identified Black patients used phone-only visits compared to 37.9 percent of Asian. Additionally, Black patients were on average 10.2 percent less likely to receive care via a video visit compared with those who identified as white.

Further, need for an interpreter and rural zip code were characteristics of audio-only telehealth usage. Around 65.5 percent of patients who needed an interpreter for their appointments used phone visits compared with 45.1 percent of patients who did not. Meanwhile, 50.9 percent of patients who lived in a rural zip code used phone visits versus 44.7 percent of those who did not.

Another important characteristic was being a Medicaid beneficiary. Those whose primary insurer was Medicaid were 12.1% more likely than those covered by other insurers to use audio-only telehealth.

There are several reasons driving the use of phone-only telehealth visits, including barriers to accessing technology, like lack of technology literacy and inadequate technology support. Income and geography also play a role in access to technology.

"Our findings support emerging literature that, despite the increasing use of smartphones and wider availability of Internet connectivity, many patients still depended on phone visits for access to care during COVID-19," the study authors wrote.

Other recent studies have also shown that underserved communities tend to opt for audio-only visits as opposed to video visits.

A recent report, by public policy research organization R Street Institute, recommends that states make flexibilities related to audio-only telemedicine services permanent.