Despite telemedicine’s rapid rise in popularity, fueled by pandemic payment incentives and temporary rule waivers, physicians and patients still prefer in-person care, according to a new study published online today in Health Affairs.
Researchers from the Harvard T. H. Chan School of Public Health conducted dual surveys: one from February to May 2021 among primary care physicians who participated in pandemic video visits and the other from April to May 2021 among patients who had a video visit with a primary care physician during the pandemic.
Of 337 primary care physicians, 90% said their pandemic video visits went well. Patients agreed, with 90% of the 1417 surveyed ranking their most recent video visit similarly, and half reporting they would have delayed care or not seen a doctor if video visits were not an option.
Still, 80% of physicians said they would prefer to provide most care in person after the pandemic, and those who experienced significant technological challenges were more likely to express this sentiment.
In contrast, 64% of patients preferred a return to in-person visits. Older patients (85%), those with less education (81%), and those who were Asian (88%) were more likely to prefer in-person visits — a nod to the “digital divide,” which typically favors younger, wealthier and White patients, study authors noted.
Although older patients have more complex medical problems that are often better addressed in person, it’s possible a lack of access or distrust in virtual platforms keeps some populations from engaging with the technology, Marty S. Player, MD, MSCR, associate professor and director of primary care telemedicine at the Medical University of South Carolina in Charleston, told Medscape Medical News.
“For younger people who have grown up in a much more digital world, a virtual visit isn’t out of step with how they interact with many other institutions,” said Player, senior author of a study on virtual urgent care that showed a similar demographic split in technological uptake.
However, Player said physicians should consider the therapeutic power that touch and physical exams produce for some patients and how that may contribute to the demand for face-to-face encounters.
Technical Woes and Worse Quality of Care
Among all participants, virtual quality of care concerns centered on the challenges of conducting a physical exam, including obtaining accurate vital signs. In addition, technical issues, such as poor internet connectivity and audio or video quality, were common, affecting at least 52% of physicians and 23% of patients.
Patients viewed virtual visits more favorably, with more than half (51%) reporting an experience equivalent to in-person appointments. Just 29% of physicians felt similarly, whereas 60% said the video visit quality of care was worse.
Perceptions of quality varied by type of care. For example, most physicians (75%) and patients (88%) reported that video visits for mental health or triage of COVID-19 symptoms were equivalent to or better than office-based appointments. But other types of care didn’t fare as well. About half (46%) of physicians said video visits were inferior for managing chronic conditions, and more than 60% felt virtual care wasn’t ideal for preventive care or acute issues like back pain.
Although telemedicine can offer greater access to care, worries over quality and technical problems may keep video visits from becoming a large portion of primary care, said the study’s authors.
And with the COVID-19 public health emergency set to end May 11, many policies supporting virtual care will also sunset. As a result, telehealth may remain underutilized without further investments in virtual physical exam technology, integrated clinical workflows, and patient education and infrastructure for underserved communities.
“Policy changes that expand reimbursement for telehealth visits and align them with reimbursement rates for in-person care could incentivize providers and increase patient access,” said Player, adding that the FY 2023 Omnibus Appropriations bill extended some telemedicine capabilities for rural health systems and Medicare beneficiaries.
“That shows policymakers understand the importance telemedicine has come to play in the American medical system,” he said.
Steph Weber is a Midwest-based freelance journalist specializing in healthcare and law.
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