Audio-Only Telehealth Visits Common for Safety-Net Providers

Telehealth increased access to care for New York State residents, with most patients attending audio-only visits compared to video visits, highlighting the digital divide that still plagues underserved communities, a study from the NYU School of Global Public Health revealed.

Like the majority of health systems and clinics across the country, community health centers in New York State adopted telehealth to facilitate healthcare delivery during the COVID-19 pandemic.

Researchers looked at 36 community health centers in the state and the visits that occurred between February and November 2020. In addition, they conducted interviews with 25 primary care, behavioral health, and pediatric providers from eight community health centers.

During the first week following the stay-at-home order in March 2020, telehealth visits accounted for nearly 40 percent of all community health center visits. By mid-April 2020, more than 60 percent of visits were conducted via telehealth, the researchers found. Telehealth visits declined steadily in August, accounting for less than 30 percent of visits.

With regard to modality, there was a clear favorite: Telephone visits were used more often than video visits at every point through November 2020.

Providers shared their thoughts about the two different telehealth modalities during the interviews. All three provider groups said that they preferred video visits over audio-only telephone visits. Video visits allowed the providers to note visual cues from patients, such as facial expressions and body language.

But, the providers also indicated that audio-only telehealth had its benefits. Telephone visits were perceived as giving patients more privacy and a stronger sense of intimacy that video calls do not offer.

Providers said that audio-only visits were easy to access in a timely manner, which helped them better manage care for patients in crises. Telephone visits were perceived to be easier for patients to access as well.

Despite preferring video visits over telephone visits, the providers agreed that both modalities are valuable.

They further acknowledged that the digital divide remains prevalent in low-income and underserved communities, which most likely contributed to the high use of audio-only visits.

Telehealth platforms can be confusing for users who have low levels of digital literacy. Additionally, all patients do not have access to technology and broadband that is needed for videoconferencing.

“Providers noted that barriers to video-enabled telemedicine, such as poor Wi-Fi connectivity, lack of access to devices with video capabilities, and limited data plans, were exacerbated in the low-income communities they served,” researchers wrote.

In order to address this digital divide, telehealth platforms should be made more user-friendly and include a support team that can help patients navigate the platform, the provider groups stated. They also called on city and community leaders to implement initiatives that increase access to free internet so patients can have the option of video visits.

As policymakers consider post-pandemic telehealth use, enacting policies that ensure coverage and reimbursement for audio-only telehealth services may be crucial for some populations. Audio-only is the sole option for some patients, and providers agree that it remains beneficial despite its drawbacks.

“Our study suggests that both video and phone visits will continue to shape how healthcare is delivered in a post-pandemic world,” Ji Eun Chang, assistant professor of public health policy and management at NYU School of Global Public Health and lead author of the study, stated in an accompanying press release.