Telehealth Survey Sees More Users for Behavioral Health Than Physical Care

A new study finds that the sharp increase in telehealth use during the height of the coronavirus pandemic was driven more by people seeking mental health services than for physical ailments.

The study, coordinated by researchers at RAND and published in the Journal of General Internal Medicine, documents a population turning to connected health in unprecedented numbers as the COVID-19 crisis pushed providers to reduce in-person care. It also points out that the momentum might not be sustainable after the pandemic if federal and state officials don’t take steps to ensure easy and equitable access.

“While the increased use of telehealth was widespread, some groups of Americans reported using the services less often than others,” Dr. Shira H. Fischer, the study's lead author and a physician researcher at RAND, said in a press release. “If telehealth use is going to remain high, we need to ensure equity of access, particularly for behavioral health care where education, age, and gender were all associated with levels of use.”

The study, based on more than 2,000 responses to survey issued in May 2020, found that almost half turned to telehealth to continue accessing care when the pandemic took hold. Of that number, about 54 percent said they were seeking help for a behavioral health concern, while 43 percent sought treatment for a chronic physical health condition.

Prior to the pandemic, some 40 percent were seeking care for a chronic health condition, while only 15 percent were seeking care for a behavioral health concern.

The numbers point to a strong need for increased access to and coverage of telemental health after the pandemic, especially in light of rising rates of depression, stress and substance abuse.

Another take-away from the survey is more troubling.

According to researchers, the dramatic increase in telehealth was driven by patients who wanted to continue seeing their own doctors, many of whom shut down their offices and switched to virtual care to reduce the risk of contracting the virus. As the public health emergency ends and providers return to in-person care or a hybrid telehealth model, those patients will likely ditch telehealth in favor of going back to the doctor’s office.

“Prior to the pandemic, patients frequently were reluctant to use telehealth because it often meant seeing a provider other than their own physician,” RAND said in its press release. “According to researchers, sustaining the ability to see one's own doctor through telehealth may be critical to making telehealth a permanent part of routine health care.”

This suggests a need for two separate strategies going forward to improve telehealth adoption.

One would focus on convincing patients that virtual care isn’t a replacement for in-person care with one’s primary care provider, but can be used to reduce wasteful expenses – for both patient and doctor – and even improve the level of care.

The second strategy would focus on proving that direct-to-consumer telehealth platforms that put the patient in front of an available care provider – not one’s own PCP – are valuable to improving timely access to care, particularly for episodic care. For someone accustomed to seeing a particular doctor, a telehealth visit with another provider could be more appropriate for a quick, one-time care concern, especially if one’s PCP is busy and a scheduled appointment may take days or weeks.

Among other highlights of the study, researchers found that the use of synchronous (audio-visual) telemedicine jumped to 11 percent as the pandemic gained steam between March and May of 2020; in contrast, less than 4 percent were using an audio-visual platform during that same time period the year before. And of those using video, 30 percent were seeking behavioral health services and 14 percent were seeking physical health care.

Researchers credited emergency measures enacted during the coronavirus for compelling providers to use telehealth.

“This shift to telehealth, particularly video, was enabled by time-limited, regulatory changes related to reimbursement, privacy standards for telehealth technology, and licensure,” the study reported. “Post-COVID-19 policies will determine whether telehealth remains central to US health care or returns to the periphery. Decisions should be informed by information about how patients used telehealth during the crisis.”