Disconnected: a survey of users and nonusers of telehealth and their use of primary care

Abstract

Objective The study sought to assess awareness, perceptions, and value of telehealth in primary care from the perspective of patients. Materials and Methods We conducted a cross-sectional, Web-based survey of adults with access to telehealth services who visited healthcare providers for any of the 20 most-commonly seen diagnoses during telehealth visits. Three groups were studied: registered users (RUs) of telehealth had completed a LiveHealth Online (a health plan telehealth service provider) visit, registered nonusers (RNUs) registered for LiveHealth Online but had not conducted a visit, and nonregistered nonusers (NRNUs) completed neither step. Results Of 32 831 patients invited, 3219 (9.8%) responded and 766 met eligibility criteria and completed surveys: 390 (51%) RUs, 117 (15%) RNUs, and 259 (34%) NRNUs. RUs were least likely to have a primary care usual source of care (65.6% vs 78.6% for RNUs vs 80.0% for NRNUs; P < .001). Nearly half (46.8%) of RUs were unable to get an appointment with their doctor, and 34.8% indicated that their doctor’s office was closed. Among the 3 groups, RUs were most likely to be employed (89.5% vs 88.9% vs 82.2%; P = .007), have post–high school education (94.4% vs 93.2% vs 86.5%; P = .003), and live in urban areas (81.0% vs 69.2% vs 76.0%; P = .021). Conclusions Telehealth users reported that they relied on live video for enhanced access and were less connected to primary care than nonusers were. Telehealth may expand service access but risks further fragmentation of care and undermining of the primary care function absent better coordination and information sharing with usual sources of patients’ care.

HCI for health and wellbeing: Challenges and opportunities

“…However, digital tools have made new forms of telecare possible. Examples include online triage and digitally enabled care at home (Pols, 2012), video conferencing in primary care (Liaw et al, 2019), the use of chatbots to mediate selected aspects of care (Palanica et al, 2019) and the introduction of AI technology for triage and diagnosis. With these, those with uncomplicated health needs may receive a diagnosis and, if required, a prescription without direct interaction with a health professional (Iacobucci, 2017).…”

“…With these, those with uncomplicated health needs may receive a diagnosis and, if required, a prescription without direct interaction with a health professional (Iacobucci, 2017). Such changes in care delivery have been found to be attractive to some patients -typically, technologically sophisticated people without complex care needs -but it requires substantial changes in the ways that care is delivered (Liaw et al, 2019). Two particular causes of concern are the knock-on effects on traditional healthcare organisation, which may be required to manage more people with complex health needs than they have capacity for, and limited validation of the algorithms underpinning patients' interactions and the delivery of diagnoses (The Lancet, 2018).…”

Recognising and responding to intimate partner violence using telehealth: Practical guidance for nurses and midwives

“…To date, few studies have examined inequities in telehealth access and uptake among individuals experiencing IPV (e.g. Liaw et al, 2020). Second, it is imperative that providers continually problem‐solve with individuals experiencing IPV with limited telecommunications access or capacity so as to effectively deliver technological, financial and operational assistance, as well as IPV assessment and care.…”

From Leather Bags to Webcams, the Emerging Tools of Tele-primary Care

“…The average Medicare beneficiary utilizes four different practices and seven separate physicians. 2 We cannot afford for this statistic to worsen. Literature on use of telemedicine for discrete conditions shows a trend toward overprescribing, generally less consistent guideline-concordant therapy, [8][9][10][11] varying appropriateness of diagnostic testing, 8,[10][11][12] and shorter follow-up intervals.…”

“…The average patient spends more than 2 hours for every medical appointment between time spent traveling and waiting in the office. [2][3][4] Virtual visits eliminate travel, minimize time away from work, and may improve patient experience with immediate care in the privacy of their own homes. Private telemedicine is available to anyone with internet and a smart phone.…”