Although clinician comfort with technology impacts the success rate of video visits, patient characteristics such as advanced patient age loom large.
Patient characteristics including older age and ethnicity are associated with the successful completion of video telemedicine visits, a new research article says.
Telemedicine visits have increased exponentially during the coronavirus pandemic. Challenges associated with access to telemedicine services such availability of broadband service for patients have raised concerns about equity.
The new research article, which was published by JAMA Network Open, examines the results of a quality improvement study of more than 130,000 scheduled video visits at an academic health system between March 1 and Dec. 31, 2020. Video visits were considered a success if the service was completed. Video visits were considered a failure if they were converted to a telephone visit.
The study generated several key data points.
- 90% of video visits were successful and 10% were converted to telephone visits
- Lower clinician comfort with technology was associated with conversion to telephone visits (odds ratio 0.15)
- Advanced patient age (66 to 80 years old) was associated with conversion to telephone visits (odds ratio 0.28)
- Lower patient socioeconomic status including low access to high-speed Internet was associated with conversion to telephone visits (odds ratio 0.85)
- Patient ethnic and racial minority status was associated with conversion to telephone visits (for Black and African American patients, the odds ratio was 0.75)
- Relatively high patient income ($75,001 to $213,000) was associated with successful video visits (odds ratio 1.18)
- Patient use of a tablet or laptop was associated with successful video visits (odds ratio 1.41)
"As policy makers consider expanding telehealth coverage and hospital systems focus on investments, consideration of patient support, equity, and friction [such as access to smartphones, computers, and quality Internet connections] should guide decisions. In particular, this quality improvement study suggests that underserved patients may become disproportionately vulnerable by cuts in coverage for telephone-based services," the research article's co-authors wrote.
Interpreting the data
Patient characteristics were the primary variable determining whether a video visit was successful or a failure, the research article's co-authors wrote.
"Clinicians were associated with some variability as a part of the equation, especially those working remotely, with poor network or with Wi-Fi network dropped connections, or those learning how to manage new equipment and workflows. However, this study showed that most of the variability in successful or failed video visits was associated with patient characteristics versus clinician characteristics, particularly regarding sociodemographic characteristics and age," they wrote.
Sociodemographic characteristics of patients such as Internet connectivity and technology literacy are essential to the success of a video visit, the co-authors wrote.
"Internet connection with sufficient bandwidth to facilitate a video visit is often a hurdle for various populations. One-fourth of rural households do not have access to broadband Internet; the digital divide is also present in urban communities, emphasizing the necessity of more inclusive Internet access. Video communication yields higher patient understanding and satisfaction compared with only telephone communication," they wrote.
Several factors may contribute to older patients converting video visits to telephone visits, and this group can benefit from telemedicine visits, the co-authors wrote.
"Older individuals may face more technology barriers, may have visual or movement disorders that make computing more difficult (especially on smaller devices), or may simply be more casual users of the Internet. Despite those assumptions, individuals who are older likely have a higher need for virtual care associated with transportation challenges to and from appointments or other impairments or chronic ailments that make leaving the house difficult," they wrote.
There is a learning curve that impacts the success or failure of video visits, the co-authors wrote.
"As patients and clinicians in the study population became more comfortable with technology, distinct learning curves were found in both user categories. The existence of a learning curve suggests that there are modifiable telemedicine program components, such as technical support or training, that may reduce video visit failures. Previous studies have shown that effective clinician training in telemedicine increases clinician confidence not only in using medical technology but in educating patients in how to have a successful video visit," they wrote.
The research article has important implications for policy makers and healthcare providers, the co-authors wrote.
"A future focus for policy makers should consider inclusion of telephonic services as a form of reimbursable telemedicine. Permanent expansion of low-cost or free broadband Internet for at-risk populations is also critical. For healthcare systems, it will be imperative to improve the ease of use of telemedicine as well as to provide support for patients to access such services," they wrote.
Christopher Cheney is the senior clinical care editor at HealthLeaders.
Video visits were considered a success if the service was completed. Video visits were considered a failure if they were converted to a telephone visit.
Lower patient socioeconomic status including low access to high-speed Internet was associated with conversion to telephone visits.
Patient ethnic and racial minority status was associated with conversion to telephone visits.