Among Clinicians, Perceptions of Telehealth Affect Remote Care Utilization Rates

A new study compared the telehealth perceptions of mental health, primary care, and specialty care clinicians, as well as use of video versus phone telehealth.

Perceptions of telehealth vary between mental health (MH), primary care (PC), and specialty care (SC) clinicians, with an impact on remote care utilization rates, a new research article says.

Utilization of video and phone telehealth has expanded exponentially during the coronavirus pandemic as a way to limit patient and staff exposure to infection. Clinician perceptions about telehealth may affect utilization—a survey conducted early in the pandemic found Veterans Health Administration PC and SC clinicians were more likely to prefer phone over video care but MH clinicians were inclined to prefer video care.

The new research article, which was published by JAMA Network Open, features survey data collected from more than 800 clinicians in the Department of Veterans Affairs New England Healthcare System, which serves about 260,000 veterans annually. The survey was conducted from August to September 2021.

The study generated several key data points.

• Relative to PC and SC clinicians, MH clinicians gave video care the highest rating, and they had a greater preference for treating new and established patients remotely with video
   
• PC and SC clinicians had a greater likelihood of rating the quality of phone care as at least equivalent to video care for new and established patients
   
• PC and SC clinicians were more likely to note challenges of video care such as patient barriers and inability to have a physical examination
   
• In providing remote care to established patients, the majority of PC and SC clinicians either had no preference for telehealth modality or preferred phone care
   
• Utilization rates reflected clinician preferences and perceptions, with MH clinicians significantly more likely to conduct telehealth visits with video compared to PC and SC clinicians

"This survey study found significant specialty-level differences in clinician attitudes toward video and phone telehealth care, many of which aligned with observed differences in actual utilization of these modalities. Our findings suggest that in the absence of financial incentives, clinician beliefs, particularly regarding the quality and ease of use of telehealth, played an important role in the care modalities that were ultimately used with patients," the study's co-authors wrote.

Interpreting the data

MH clinicians conducted the highest proportion of video visits during the time of the survey. "MH clinicians were also more likely to report that their selection of care modalities was influenced by leadership guidance and data regarding the relative effectiveness of video, phone, and in-person care. Indeed, given that telehealth was being used for MH care well before the onset of the COVID-19 pandemic, there is a strong body of evidence demonstrating that video care is noninferior to in-person MH services, as well as an emerging literature suggesting that phone care may sometimes be inferior in quality to video care," the study's co-authors wrote.

PC and SC clinicians were less likely than MH clinicians to prefer video over phone telehealth visits, the study's co-authors wrote. "PC and SC clinicians, who conducted substantially less video care than MH, had multiple similarities in their responses across the survey. These clinicians were more likely to rate phone care as being at least equivalent in quality to video. They were also more likely to endorse challenges of video care, including patient barriers to use and the inability to conduct an adequate physical examination. Importantly, most PC and SC clinicians either had no preference or preferred phone for remote care of established patients."

PC clinicians provided the highest proportion of phone visits for established patients. "This could be owing, in part, to their increased likelihood of endorsing challenges of video care coupled with a tendency to believe that video and phone care are equivalent in quality, particularly for established patients. Indeed, most PC clinicians either preferred phone or had no preference between phone and video for the remote care of established patients. This finding underscores the importance of complexity in influencing adoption of new technologies; if PC clinicians believe that phone and video care are equivalent in quality, ease of use may then drive the choice of phone over video, particularly when treating patients whom they have already seen in-person," the study's co-authors wrote.

Most of the MH, PC, and SC clinicians reported that patient preference was a major contributor to selecting a telehealth modality. However, even though there is evidence that patients increasingly prefer video over phone visits, utilization data show that a significant proportion of telehealth visits are being conducted by phone. "It is unclear how often what we refer to as patient preference is instead a measure of patient readiness for telehealth (i.e., that the patient owns a video-enabled device or is comfortable navigating a telehealth platform). A patient without a smartphone may be viewed as preferring a phone appointment because they do not have access to the appropriate technologies. Indeed, COVID-19 has revealed a stark digital divide in which patients who are older and/or have lower income are less likely to be video-ready," the study's co-authors wrote.

Related: Study Links Physician Characteristics to Telehealth Adoption