High use of telehealth is tied to care gaps

The COVID-19 pandemic led to a rapid increase in telemedicine use among doctors, from around 15% in 2019 to over 86% in 2021. While telehealth use is still high, questions remain about how care is affected by the lack of in-person interaction between doctors and their patients. 

 Findings published Feb. 17 in JAMA Network Open showed that, among primary-care patients, having telehealth visits make up only a small part of their overall care was associated with a quality of care comparable to that of in-person visits. But choosing virtual visits more than 50% of the time was associated with lower quality care, especially for certain services like vaccines.  

 It is the first national study to look at whether the proportion of visit types affected care quality. 

 “Our study showed many different combinations of in-person care and telehealth are viable for high quality care, but it also underscored the importance of in-person care,” said first author Dr. Jonathan Staloff, a family medicine physician and acting assistant professor of family medicine at the University of Washington School of Medicine.  

The study followed 744,599 U.S. military veterans using Veterans Health Administration primary care for three or more visits in person or by video or phone. Patients with a low or moderate proportion of virtual visits received about the same quality of care as those seeking in-person care. Patients who used telehealth most of the time had consistently lower rates of flu vaccination, statin adherence and depression screening compared with those who had sought in-person care. 

The researchers acknowledged that telehealth helps people overcome possible access issues such as lengthy waits for an in-person appointment, lack of transportation, or problems with being absent from work. 

To ensure that telehealth high users receive services like vaccinations that require in-person care, the study authors think that utilizing community partnerships is key to ensuring quality care. 

“For instance, to increase immunizations among patients primarily using telemedicine, healthcare systems can have mobile health clinics or vaccination vans go into areas with low vaccination rates,” Staloff said. “Doctors can also communicate with community pharmacies, where patients go to pick up their medications, that a patient is a high risk for not getting a particular vaccine. Partnering in this way creates an opportunity to close the gap.” 

He continued: “While I think it's very important that patients still be seen in-person for most of their care, much of medical care can be informed by a conversation between the doctor and patient, and by medical data that can be provided by remote monitoring. These findings show that telehealth, if done in moderation, can help facilitate access to care without having a major negative impact on quality.”  

The paper’s senior author was Dr. Ashok Reddy, associate professor of medicine at the UW School of Medicine.  

The Veterans Health Administration Primary Care Analytics Team, funded by the VHA Office of Primary Care, supported this research. 

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