Who uses virtual visits, and why? Here’s how primary care doctors and patients can benefit.
While the pandemic was the impetus for greater utilization of telehealth across the health care continuum, it's safe to say that due to the convenience and benefits it offers to patients and providers, telehealth is here to stay.
Before COVID-19, telehealth visits only accounted for 4% of total appointments, according to our recent research, which evaluated telehealth usage across 93.7 million patients in our athenaOne network. In the first half of 2022 when many patients returned to receiving in-person care, virtual visits still accounted for 8.9% of total appointments – a relatively minor decrease from the 12.1% we saw at the pandemic’s height. In addition to large-scale utilization, it is also evident that telehealth is being leveraged for a wide range of use cases. The network research, in addition to a survey we commissioned through Dynata of 2,000 U.S. patients, both found interesting patterns in usage for behavioral health, chronic care, as well as differences in adoption across race and gender.
Despite differences in adoption and utilization, one thing is clear: Telehealth will remain a pivotal component of health care delivery now and in the years to come.
Telehealth proved to be an extremely helpful tool for those seeking mental health care during the pandemic. In fact, 25% of Dynata survey respondents shared that they turned to telehealth for a mental health appointment, while 23% indicated they were more likely to seek out mental health support because of the availability of telehealth. New mental health diagnoses of anxiety and depression occurred 1.8 times more during telehealth appointments compared to in-person appointments, according to our network data. The metrics are encouraging. They demonstrate that telehealth is improving access to mental health care by giving patients the opportunity to connect more seamlessly with their providers and do so more frequently. Additionally, the findings suggest that telehealth has the potential to lessen societal stigma and personal anxieties around using mental health care services. Another notable finding was that in addition to behavioral health, primary care and pediatrics were the most likely specialties to adopt telehealth. This points to the idea that telehealth can be a cornerstone to care in primary care practices that offer mental and behavioral health services to their patients. Ultimately, the pandemic pushed telehealth utilization to the forefront out of necessity, but now it’s solidifying its place in the care continuum by filling an unmet need for mental health care.
Telehealth technology has also emerged as a critical tool for chronic care management and for communication between patients and providers. In fact, after adjusting for other patient characteristics, our network data shows that patients with chronic conditions are 35% more likely to adopt telehealth than patients without chronic conditions, and survey respondents said they are 56% more likely to use it moving forward. This is important, because with more frequent touchpoints, chronically ill patients can receive more consistent care for their conditions.
Not only are chronically ill patients communicating with their providers, but they are also leveraging telehealth on a more continued basis versus one-off visits. Nearly a quarter (23%) of Dynata survey respondents reported that their telehealth visits were for regularly scheduled chronic care appointments and 9% said they turned to telehealth for ad hoc appointments to manage concerns related to their chronic condition.
Overall, the findings suggests that telehealth can serve as an efficient care delivery tool, helping primary care providers connect with their chronically ill patients more often. This in turn drives better health care outcomes and potentially reduces patient reliance on emergency rooms or urgent care settings – allowing for providers to focus on high-priority patients.
To better understand how we can advance health equity as an industry, we also need to understand the differences in telehealth utilization across demographics. Most notably, we found there’s a very nuanced picture to telehealth utilization across different races. Telehealth presents an opportunity to improve care coordination, provide more stable access to affordable care, and allow care teams to better collaborate and understanding how different races and genders leverage telehealth will help enhance care over time and improve health equity.
For example, our network data research found that Black and Hispanic patients were 20% more likely to use telehealth services than White patients. However, the White patient population is using it in a much different way. When White patients use telehealth, they’re much more likely to use it in the context of a continuous relationship with a provider, such as their primary care doctor. For example, a White patient sees their doctor in-person to manage their diabetes and then has a follow-up appointment via telehealth. When Black and Hispanic patients use telehealth, it’s more often in the context of an ad hoc appointment for an urgent issue, for example, a sinus infection. Hispanic patients are 8% less likely to use telehealth with a dedicated provider and Black patients are 12% less likely. This demonstrates that while telehealth is improving access to care for minority patients, it’s not yet solving care continuity, which we know is extremely impactful in improving health outcomes for all.
In addition to race, there are prominent gender differences around telehealth utilization for both patients and providers. According to our network data, both male patients and providers were less likely to use telehealth than female patients and providers. Younger, female physicians practicing primary care and behavioral health were most likely to adopt telehealth. Male physicians were 24% less likely to leverage telehealth, while male patients were 15% less likely to attend a telehealth appointment. We’ve seen similar gender patterns emerge in previous research. For example, female physicians spend more time on patient appointments and on after-hours patient care documentation than male physicians.
As health leaders evaluate telehealth adoption and continued integration of the technology within their practices, it’s very important they consider not only how their patient population is leveraging telehealth, but also their ecosystem of clinicians. They can then determine ways telehealth can be leveraged to create and build stronger provider-patient relationships. Telehealth technology can drive better outcomes and fill care gaps when used as an extension of in-person visits as it supplements high-quality in person care with more frequent touchpoints.
As telehealth is further integrated into the care continuum, it is likely that it will continue to assert its place as an extension of in-person care rather than a replacement. Continued research around adoption and utilization will be key to better understand how physicians and patients are benefiting from the technology (and nuanced areas on how it can be improved for maximum impact across the continuum.) The benefits of telehealth will far outlast the initial impact of the technology during the peak of the pandemic and, moving forward, we’ll continue to see telehealth thrive as a pivotal tool in advancing care for all.
Jessica Sweeney-Platt is vice president for research and editorial strategy for athenahealth. She is a business leader with 23 years' experience in managing research teams and executive education offerings and subject matter expert in hospital-physician integration, health care strategy, and culture change.