Prevalence and Characteristics of Telehealth Utilization in the United States

Shira H Fischer,Ateev Mehrotra,Lori Uscher-Pines,Kristin N Ray,Erika Litvin Bloom

doi:10.1001/jamanetworkopen.2020.22302

Shira H Fischer, Ateev Mehrotra + Show 3 more

Open Access

https://doi.org/10.1001/jamanetworkopen.2020.22302

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Abstract

Telehealth services, which allow patients to communicate with a remotely located clinician, are increasingly available; however, prevalence of telehealth use, including videoconferencing visits, remains unclear. To measure the use of and willingness to use telehealth modalities across the US population. This survey study, conducted between February 2019 and April 2019, asked participants about their use of different telehealth modalities, reasons for not using videoconferencing visits, and willingness to use videoconferencing visits. Questions were continuously posed to panel members and closed after 2555 responses were obtained, at which point 3932 panel members had been invited, for a 65.0% response rate. Demographic characteristics (ie, age, sex, race, rural/urban residency, education level, and income). Self-reported use of specific telehealth modalities, reasons for nonuse, and willingness to use videoconferencing in the future. A total of 2555 individuals completed the survey with a mean (SD) age of 57.2 (14.2) years; 1453 respondents (weighted percentage, 51.9%) were women, and 2043 (weighted percentage, 73.4%) were White individuals. Overall, 1343 respondents (weighted percentage, 50.8%) reported use of a nontelephone telehealth modality, ranging from 873 respondents (weighted percentage, 31.9%) for patient portals and 89 respondents (weighted percentage, 4.2%) for videoconferencing visits. Although 1309 respondents (weighted percentage, 49.2%) overall answered that they were willing or very willing to use videoconferencing visits, respondents who were Black individuals (OR, 0.58; 95% CI, 0.38-0.91), aged older than 65 years (OR, 0.51; 95% CI, 0.40-0.66), or had less education (high school or less vs advanced degrees: OR, 0.37; 95% CI, 0.25-0.56) were less likely to express willingness. Despite the focused policy attention on videoconferencing visits, the results of this survey study suggest that other forms of telehealth were more dominant prior to 2020. Targeted efforts may be necessary for videoconferencing visits to reach patient groups who are older or have less education, and payer policies supporting other forms of telemedicine may be appropriate to enhance access.

Highlights

In 2020, tasks that once required traveling to a physical location are increasingly accomplished from home with a smartphone, including ordering groceries and depositing checks.[1]
Despite the focused policy attention on videoconferencing visits, the results of this survey study suggest that other forms of telehealth were more dominant prior to 2020
We focused on nontelephone telehealth modalities that have only become more widespread in health care in the past decade, such as e-visits, videoconferencing visits, patient portals, and email

Summary

Introduction

In 2020, tasks that once required traveling to a physical location are increasingly accomplished from home with a smartphone, including ordering groceries and depositing checks.[1] The use of personal electronic devices to improve access and convenience has spread to health care. Various forms of telehealth services, including text messaging, email, patient portals, videoconferencing visits, and e-visits are becoming increasingly available in the US,[2] and have the potential to increase access to care and reduce health disparities among rural and underserved populations.[3,4] until the coronavirus disease 2019 (COVID-19) pandemic began in March 2020, use of telehealth was relatively rare, and estimates of telehealth adoption in the US were variable and had numerous limitations.[5,6,7,8,9] For example, studies commonly focused on only 1 form of telehealth, used inconsistent definitions of telehealth, and/or engaged small, nonrepresentative samples. To characterize the current increase in telehealth adoption spurred by the pandemic, it is important to understand baseline utilization

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