Type of chronic condition may dictate telehealth use

The type of chronic condition a person has may influence whether they receive care in person or through telehealth, with factors like the need for physical examinations or laboratory testing driving the appointment type, according to new research.

Published in JAMA Network Open, the study aimed to assess whether chronic conditions, in addition to sociodemographic factors, are associated with the probability of receiving in-person, audio-only or video-based care.

Researchers conducted a cross-sectional study using data from Veterans Health Administration patient EHRs between April 1, 2022, and March 31, 2023. They examined in-person, video or telephone outpatient primary care encounters, recording how frequently 39 chronic conditions were coded by care modality.

The study included 7.14 million primary care visits, representing 3.97 million veterans. Of the visits, 83.2% were in-person appointments, 11.1% were telephone-based and 5.8% were video-based visits. The five most frequently coded chronic conditions across all visits were hypertension, hyperlipidemia, diabetes, mental health conditions, like anxiety, depression or post-traumatic stress disorder, and lower back pain.

However, researchers found that chronic conditions dependent on physical examinations or laboratory assessments were less likely to be performed via telehealth. For instance, conditions with the highest percentage of care completed via video included HIV or AIDs, migraine, traumatic brain injury and multiple sclerosis, while conditions with the lowest percentages of care completed via video included deafness and hearing impairment, peripheral vascular disease and ischemic heart disease.

In total, 21 conditions were less likely to occur via telephone and video and more likely to occur in person when the condition was documented compared with visits where the condition was not documented. These included chronic obstructive pulmonary disease, atrial fibrillation, cancer and asthma. Only three conditions were more likely to occur via audio-only or video-based telehealth when the condition was documented versus not: heart failure, HIV or AIDS and mobility impairment.

"As healthcare systems continue to use and develop more robust telehealth infrastructure, these findings may be helpful in building models, pathways and guidelines for such programs and clinical care…Additionally, understanding variations in the use of telehealth is critical to informing future priorities for telehealth reimbursement policies, which remain a major factor of telehealth adoption outside the VHA healthcare system," the researchers concluded.

Amid declines in telehealth utilization, understanding when and which patients use telehealth is critical to program implementation efforts.

For instance, though video-based telehealth is as effective as in-person care in treating certain conditions, recent research reveals various demographic disparities linked to video visit utilization. The study published this month included video visit telemetry data and EHR appointment information for 30,996 scheduled video visits between Sept. 1, 2020, and Nov. 30, 2020.

The researchers found that patients older than 65 were 102% more likely to experience a failed video visit than those younger than 65. Further, Black patients were 56% more likely to have a failed video visit than white patients.

Not only that, but research also shows that telehealth use varies by specialty type. A study published in August 2024 found that between Jan. 1, 2021, and July 1, 2022, the mental health, endocrinology and genetics specialties had higher telehealth usage, while telehealth use in cardiology, dermatology and obstetrics-gynecology spiked in March and April 2020, but declined after.

Anuja Vaidya has covered the healthcare industry since 2012. She currently covers the virtual healthcare landscape, including telehealth, remote patient monitoring and digital therapeutics.