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Evaluation of telemedicine as an option for providing safe, accessible, care to young adults in a university setting.

Diane Lynch Follow

Date of Award

Fall 10-18-2021

Degree Type

Dissertation

Degree Name

PhD Nursing Practice

Mary Ellen Roberts, DNP

Committee Member

Margaret Huryk, DNP

Melissa Mascaro, MD

telemedicine, telehealth, college students, satisfaction, utilization

Previously underutilized, telemedicine has been implemented within a wide variety of health settings as a safe and efficient way of delivering healthcare during the COVID-19 pandemic. Maintaining operations during the pandemic made implementation of telemedicine an important aspect of college and university health center reopening plans. The purpose of this project was to evaluate the acceptance and quality of a telemedicine program implemented at the health center of a medium sized private university.

Data were collected via patient and staff surveys to measure satisfaction with the program and a retrospective review of electronic medical records was conducted to obtain data regarding utilization of telemedicine services. Baseline usage of telemedicine was collected 4 weeks following initiation of the program and again 16 weeks later to measure staff and patient acceptance of the program. Student access to healthcare providers was evaluated by comparing student access to providers with extended telemedicine hours during the 2020-2021 academic year with standard office hours.

Use of telemedicine resulted in an increase in access to university healthcare providers by 32 hours per week during the Fall 2020 and Spring 2021 semesters. Student satisfaction with the program increased significantly between the fall and spring semesters with overall satisfaction growing from 62% in the fall to 92% in the spring and a year-end staff survey and campus partner interviews showed strong support with 100% of participants recommending continuation of the program. The findings suggest that telemedicine can be used to successfully deliver quality care and extend access to care providers in a college health setting.

Recommended Citation

Lynch, Diane, "Evaluation of Telemedicine as an Option for Providing Safe, Accessible, Care to Young Adults in a University Setting" (2021). Seton Hall University Dissertations and Theses (ETDs) . 2935. https://scholarship.shu.edu/dissertations/2935

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Telemedicine during and beyond COVID-19

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COVID-19 is causing an unprecedented stress on health systems and healthcare delivery. Health systems and services are being reconfigured to maintain patient continuity. Telemedicine has provided an enabling tool to maintain patient continuity and management of patients during COVID-19. It has allowed ...

Keywords : COVID-19, Telemedicine, Telehealth, Coronavirus

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April 2022 — Volume 6, Issue 1 Back

Knowledge, attitudes and perceptions on the use of telemedicine among adults aged 18-34 in manila, philippines during the covid-19 pandemic.

Kate Antoinette D. Umayam, Alexandra Nicole N. Rosadia, Rosanne Nicole R. Tan, Denise Julianne R. Salazar, Roanie Lian L. Masakayan, Gian Marcean B. Santiago, Miguel Antonio M. Monzon, Clarenz Sarit M. Concepcion

Apr 2022 DOI 10.35460/2546-1621.2021-0144

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Figures and Tables

Introduction.

Telemedicine has emerged as a modern healthcare delivery service platform due to the rapid development in communications technology[1]. It is the use of any form of telecommunications technology to provide healthcare services between the physician and patient who are at different locations. Presently, the advancements made by the availability of the internet widened the scope of telemedicine. Telemedicine could now be made available over the internet through the use of different web-based technologies such as e-mails and other forms of web interactions[2]. Due to the COVID-19 pandemic, the delivery of healthcare services virtually has been on the rise since. The limitations and restrictions, protocols to reduce transmission risk brought about by this situation accelerated the need for alternative ways of conducting health consultations[3]. However, effective healthcare delivery through telemedicine is not guaranteed[3]. Despite the promising potential of telemedicine, the uptake has been scarce for both healthcare professionals and patients in the Philippines. The COVID-19 pandemic emphasized that a large proportion of healthcare professionals are not properly trained in conducting virtual consultations[4]. In addition, the study by Checcucci et al.[5] also showed that most patients, or interviewees, did not have access to the basic requirements needed to conduct telemedicine consultation (computer, smartphone, tablet and internet connection).

With the ongoing COVID-19 pandemic, it is possible to see a change in the perceptions of Filipinos towards telemedicine as travel restrictions limit the movement of the population and as fear and anxieties of people for hospitals grow. Given this situation, this study will examine the KAP of 18-34 year olds on telemedicine. It is necessary to consider the standpoint of the public regarding this intervention knowing that they are directly involved. This study will provide a way to gauge the knowledge and perceptions on, and acceptance of telemedicine in the Philippine setting which can help in understanding whether telemedicine is worth pursuing. This will be beneficial to the community, doctors and medical personnel, and future researchers.

This study was limited to the KAP of respondents on telemedicine during the COVID-19 pandemic. As knowledge cannot be physically measured by an instrument, the use of the word refers to the individual’s perceived knowledge about telemedicine. Due to the ongoing pandemic, this study was conducted through an online questionnaire.

Methodology

Research Design

This study utilized a cross-sectional community survey design with a descriptive quantitative correlational method. Quantitative data collected through a survey questionnaire will help in determining the respondents’ attitude towards telemedicine and if there is a significant relationship between their KAP on telemedicine and their intent of use. A comparative analysis on the respondents’ socio-demographic profile was also conducted to further understand the relationship of the variables under study.

This research made use of purposive sampling and 322 eligible respondents participated in the study. This yielded a 5% margin of error at 95% confidence interval, calculated using the Raosoft Inc. sample size calculator from the estimated 14,158,573 total population of Manila, Philippines[6].

The criteria for inclusion were Filipinos who are aged 18-34 years old, reside in Manila, Philippines, have not participated in any form of telemedicine previously, and are able to use electronic gadgets, and read and understand English and/or Filipino. A Manila resident is a person whose address on a driver's license, a voter registration card, a lease, an income tax return, property tax bills, or utility bills is Manila City. Those who do not fall within these criteria were excluded from the study.

Data Measure/Instrumentation

A survey questionnaire composed of three main parts (socio-demographic profile, knowledge on telemedicine, and attitudes and perceptions on telemedicine) was utilized for this study. The said questionnaire was adapted from Ayatollahi et al.[7] and Lin[8] but was modified to better fit the current study. Knowledge focused on the individual’s perceived knowledge, or self-assessment of knowing the information; attitude is referred to as the level of acceptance towards the use of telemedicine that may either be positive or negative, while; Perception is the belief on the use of telemedicine.

The first part of the questionnaire was in the form of a simple question and answer. The second and third part was in the form of a Likert scale ranging from 1 to 5 where 1 = Very Low and 5 = Very High, and 1 to 7 where 1 = Strongly Disagree and 7 = Strongly Agree. Scores for the second and third part were summarized, transformed to scores ranging from 0-100, and interpreted using a specified scale for each section. Each respondent’s scores were computed by summing up their responses on each section of the questionnaire. Since the range of scores differ per section (the number of items per section are not the same), a linear transformation was used to force the scores to be bounded between 0 and 100.

Prior to data gathering, pilot testing was done and the survey questionnaire used was subjected to Cronbach alpha testing for validity and reliability. All sections of the used questionnaire got an internal consistency ranging from acceptable (0.75) to excellent (0.91).

Data Gathering Procedure

The study was conducted using a survey questionnaire through Google Forms to gather the needed data. The questionnaire was disseminated using social media platforms (Facebook, Messenger, and Instagram) since face-to-face collection of data was not possible due to the pandemic. Consent letters were provided to the respondents before they participated in the study to seek permission to be a part of the research process. After the data had been collected, it was sorted and organized prior to analysis and interpretation. Personal information and other data gathered from the questionnaire were given unique codes, and stored in a locked folder. These were all kept in a password protected computer wherein the gathered data will be deleted and destroyed two years after the study has concluded. No information was publicly reported in any way that may identify the participant. Data was not made available for secondary use outside this study.

Ethical Considerations

The study has been approved by the Faculty of Pharmacy Research Ethics Committee (FOPREC).

Data Analysis

The results of the data were processed for computer analysis. Tests for proportion were utilized to determine the age group of 18-34 year olds as a majority. The mean and standard deviation for each item was determined to identify where the KAP of most participants lie and if these are spread out or close to the mean. A profile analysis of KAP was utilized to determine any significant difference when analyzed according to socio-demographic variables. The analysis included three stages that test for several hypotheses. These statistical tests were used to test the second null hypothesis. Spearman’s rho was used to identify any correlation that would test the first null hypothesis.

A total of 390 respondents participated in the online survey and only 322 were eligible after data cleaning based on the inclusion and exclusion criteria of the study.

Sociodemographic Profile of the Respondents

Majority of the respondents were 20-24 years old (71.4%) and females dominated the sample comprising about 57.1% of the total respondents. In terms of highest educational attainment, around half (49.69%) of the respondents were high school graduates, 46.58% had a bachelor’s degree, and only 3.73% are postgraduate degree holders. With regard to the monthly income, exactly half of the respondents had a monthly income of Php 10,000 and below. A summary of the respondents’ sociodemographic profile is presented in Table 1.

Knowledge, Attitudes and Perceptions Towards Telemedicine

As presented in Table 2, the average score for knowledge is 41.55 with a standard deviation of 25.53 points. This indicates that the respondents had average to low knowledge on telemedicine. In terms of attitude, it has an overall mean of 67.67 with a standard deviation of 17.19 points, suggesting that the respondents had a neutral attitude towards telemedicine. Lastly, the overall score for their perceptions is 65.91 with a standard deviation of 13.88 points, which showed that they had a neutral perception towards telemedicine.

Table 3 displays the average scores of KAP of the respondents analyzed by their sociodemographic variables. For age, the 18 to 19 years old age group had the lowest knowledge score (38.71) while the 20 to 24 (42.33) years old age group had the highest score among the groups. Meanwhile, the 30 to 34 years old age group had the lowest average attitude and perception scores of 65.31 and 61.53, respectively. It also showed that there was no significant difference in the mean KAP scores of the age groups (p=0.609).

For sex, females had a higher mean knowledge score (44.02) compared to males (38.26). On the other hand, only a slight difference was observed for attitude and perception with mean scores of 67.53 and 66.36 for females, and 67.86 and 65.31 for males, respectively. It also showed that there was no sufficient evidence to conclude that KAP differs by sex (p=0.212).

For highest educational attainment, those with a high school degree and bachelor’s degree had similar scores across the three categories. Those who had a graduate degree got the lowest mean knowledge score (38.33) among the three groups but also got the highest attitude score (71.03) among the groups. With this, there was no significant difference between the respondents’ KAP and highest educational attainment (p=0.818).

For monthly income, those with a monthly income between Php 45,001 and Php 75,000 have the lowest mean KAP scores of 36.67, 61.31 and 61.35, respectively. It can be observed that there was a large variation in the knowledge scores across income groups but small variations could be observed on the attitude and perception scores. There was no significant difference between the respondents’ KAP and monthly income (p=0.428).

Table 4 displays the estimated correlation between the variables through the Spearman rank-order correlation coefficient. The correlation between knowledge about telemedicine and attitude towards the use of it was 0.3637, which indicated a weak to moderately weak positive linear relationship between the two variables. Meanwhile, the correlation between knowledge about telemedicine and perceptions towards its use was 0.4176. This indicated that there was a moderate positive linear relationship between the two variables. Lastly, the correlation between attitude and perception towards the use of telemedicine was 0.7477, indicating a strong positive linear relationship.

Majority of the participants in the study were aged 20 to 24 years old followed by 25 to 29. A study by Cranford[9] stated that individuals in the said age groups are 20% more willing to adopt technology compared to older age groups which may be the reason as to why majority of the respondents came from the same age group.

In this study, the majority (57.1%) of the participants were females. This was similar to the findings of Tingle[10] wherein females were found to utilize telemedicine services more than males would. It was also stated that 56.9% of the females completed their telehealth consultations compared to males (43.1%). Similarly, a study conducted by Escoffery[11] also concluded that females were more likely to participate in telemedicine services and demonstrate behaviors towards telemedicine or e-health services than males since females tend to seek more information regarding health issues online coupled with the advice of health professionals.

Highest Educational Attainment

Almost half (49.7%) of the respondents had at least high school education while 46.6% had a bachelor’s degree. According to Scott Kruse, et al.[12], one of the barriers to telemedicine is the level of education to which van Deursen and van Dijk[13] added that the highest educational attainment is the most important contributing factor in being equipped with internet skills. Since the majority of the respondents have middle to high level of education, it can be said that they are equipped with the necessary internet skills required to have access to telemedicine and its services.

Monthly Income

Exactly half of the respondents had a monthly income of less than Php 10,000. This may largely be because a majority of the respondents are still students (based on their age and highest educational attainment) and do not have a monthly salary. Nonetheless, the results are still supported by Ryu[2] which stated that low-income countries still have a willingness to participate in telemedicine and telehealth systems. Ryu[2] also stated that there was a desire to implement telemedicine solutions in developing countries as they see this as an opportunity to improve the current healthcare system.

Knowledge, Attitudes and Perception Towards Telemedicine

The overall knowledge of the respondents was considered average to low. In the study by Malhotra, et al.[14], low knowledge levels were attributed to a person’s lack of exposure to telemedicine. Similarly, a study conducted on physicians by Albarrak, et al.[15] showed that the participants had average knowledge of telemedicine since there were low numbers of training, workshops and meetings involving the discussion of telemedicine’s advantage. It was explained that the knowledge of the user was critical to the successful implementation of telemedicine[15]. Knowledge levels may also vary based on the length of implementation of telemedicine at a certain place[16].

The respondents were considered to have a neutral attitude towards the use of telemedicine, which was parallel to the study conducted by Kumar and McNeil[17] where majority of their respondents who had no experience in using a telemedicine product had a neutral response when it came to user acceptability of neurology telemedicine technology.

Perceptions

The respondents had a neutral perception towards telemedicine with the subcategories efficiency and financial cost obtaining fairly positive outlooks. In a study conducted by Acharya and Rai[18], a majority of their respondents were content with their telemedicine experience as it was conveniently scheduled for them. In addition to that, Dick et al. as cited in Acharya and Rai[18] mentioned that telemedicine was well accepted due to the financial savings it was able to bring. Meanwhile, the respondents had a fairly negative perception on the reliability of telemedicine. This subcategory relies on the current status of telemedicine in a particular place as stated by Bali[19]. The respondents’ view on the reliability of telemedicine may be due to its novelty as well since it was a fairly new concept to the Philippines.

Knowledge, Attitudes and Perceptions Towards Telemedicine by Sociodemographic Variables

No sufficient evidence may prove any significant differences in the KAP of respondents between 18 and 34 year olds, which could be due to the close proximity of the ages (p=0.609). Accordingly, remarkable deviations in responses within the age group were not found, but instead could be seen when they, as a whole, are compared against much older age groups. A study conducted by PwC[20], a professional services network, stated that 18 to 34 year olds are the most open to technological advancements and the digital future among any other age groups. This can also be reflected in the survey conducted by American Well[21], another telehealth service provider, which showed that it was the 18 to 34 year olds that were most inclined (41%) to transition from their primary care physicians to those who offer virtual care.

The behavior of respondents’ KAP towards telemedicine did not differ by sex (p=0.212). This is supported by the study of Haluza and Wernhart[22] that indicated the prevailing use of health applications by both male (39%) and female (42%) were already high. Therefore, there was no significant difference in the prevalence of general usage of mobile health applications between the two. Similarly, in the study of Escoffery[11], the composite e-Health literacy scale scores between male (29.69) and female (30.11) respondents presented no significant differences as both sexes were reported to have comparable perceived skills in using the internet for their health concerns.

There is no sufficient evidence that would indicate any difference when KAP is analyzed by the respondents’ highest educational attainment (p=0.818). In a study performed by Park et al.[23], university students were surveyed on their behavioral intention to use mobile learning. Their survey showed that most students have a positive attitude, behavior, perceived usefulness, and perceived ease of use, indicating that they have high acceptance of technology. It was also mentioned that more people are inclined to use information technology in every field to catch up with the rapid changes happening globally. Granić [24] mentioned that external factors could have an effect on a student’s attitude in utilizing technology. However, since there were no respondents from people without formal education, the lack of data leaves no evidence that education has a significant effect on KAP towards telemedicine.

There is no sufficient evidence that would indicate any difference when the respondents’ KAP is analyzed based on their monthly income (p=0.428). In a study done by Li[25], mobile medical treatment (MMT) users were surveyed on their attitudes and perceived ease of use. The survey showed that most users had a positive attitude and perceived ease of use which indicated a high acceptance of mobile health (mHealth) services regardless of the social demographic that includes gender, age, education level and monthly income.

Correlation of Knowledge, Attitudes and Perceptions Towards Telemedicine

A weak to a moderately weak positive linear relationship was seen between knowledge about telemedicine and attitude towards the use of it. On the other hand, knowledge and perceptions towards telemedicine have a moderate positive linear relationship. This result suggests that the likelihood of having a positive attitude and perception towards the use of telemedicine does not necessarily come from a high level of knowledge about it. This is parallel to a similar study conducted among clinicians by Ayatollahi, et al.[7] which showed that although clinicians have limited knowledge about telemedicine, a majority of the respondents still think it is necessary. Valikodath, et al.[26] explored diabetic retinopathy patients’ attitudes toward telemedicine and revealed that the majority had not heard of telemedicine but are willing to participate in such a practice. Willingness was greatly influenced by their perceived convenience of telemedicine.

Additionally, a study conducted by Patel[27] among pharmacy students revealed that 40% of the respondents are only slightly to not at all knowledgeable about telepharmacy, a part of the collective telemedicine term. Despite the low knowledge on telepharmacy, the students showed a positive perception of its relative advantage as compared to the conventional face-to-face method. A majority of them believed that the COVID-19 pandemic paved the way for practicing telepharmacy and had seen its importance as a tool to improve the clinical aspects of health care[27].

In terms of the relationship between attitude and perception towards telemedicine, these two variables have a strong positive linear relationship, meaning that the more positive attitude a person has towards the use of telemedicine, the more likely it is for them to have a positive perception about the use of telemedicine. This coincides with the results of the study by Russo, et al.[28] that investigated on the attitudes of families of pediatric patients towards telemedicine. These pediatric families showed a positive attitude along with a strong interest towards telemedicine. Specifically, families of those undergoing genetic consultation showed a positive perception towards telemedicine. In the study of Dey and Bhattacharya[16], most of their study participants appreciated telemedicine’s interactive nature and considered it as a tool that could improve both access to healthcare and quality of care. Most of these study participants expressed their willingness to use telemedicine. Moreover, Rho, et al.[29] supports how a positive attitude most likely reflects a positive perception towards telemedicine. Their study showed that perceived ease of use influenced perceived usefulness and the behavioral intention to use telemedicine.

Advances in the medical field together with the ongoing COVID-19 pandemic have caused a shift in the mode of delivery for various healthcare providers. Although telemedicine was more utilized during this pandemic, the majority still have average to low knowledge about this topic. While the behavior of their KAP does not differ per socio-demographic variable, the study concluded that positive attitudes most likely reflect a positive perception towards telemedicine but does not necessarily equate to higher levels of knowledge about telemedicine. This analysis provides a great benefit to the assessment of the public’s impression on using modern technology in consultations as an alternative to traditional clinical visits.

• Chen ET. Considerations of telemedicine in the delivery of modern healthcare. American Journal of Management . 2017 Sep 1;17(3):20–28.
• Ryu S. Telemedicine: Opportunities and developments in member states: Report on the second global survey on eHealth 2009 (Global observatory for eHealth series, volume 2). J Healthc Inform Res . 2012;18(2):153.
• Malik R, Sadler P. Remote consultations; what you need to know. MEJFM . 2020;18(10):103–6.
• Thomas E, Haydon H, Mehrotra A, Caffery L, Snoswell C, Banbury A et al. Building on the momentum: Sustaining telehealth beyond COVID-19. J Telemed Telecare . 2020. doi: https://doi.org/10.1177/1357633X20960638
• Checcucci E, Luca S, Alessio P, Verri P, Granato S, Cillis S, et al. Implementing telemedicine for the management of benign urologic conditions: A single centre experience in Italy. World J Urol . 2020. doi: 10.21203/rs.3.rs-84267/v1
• World Population Review. Manila population 2021 (Demographics, maps, graphs) [Internet]. World Population Review 2021. Available from: https://worldpopulationreview.com/world-cities/manila-population
• Ayatollahi H, Sarabi FZP, Langarizadeh M. Clinicians' knowledge and perception of telemedicine technology [Internet]. PubMed. 2021. Available from: https://pubmed.ncbi.nlm.nih.gov/26604872/
• Lin Z. The overall perception of telemedicine and intention to use telemedicine services: A comparison between frequent travelers and non-frequent travelers [Internet]. eCommons Cornell . 2017. Available from: https://ecommons.cornell.edu/handle/1813/56813
• Cranford L. Study provides insights on telemedicine's generation gap. Chiron Health . 2017. Available from: https://chironhealth.com/blog/study-provides-insights-telemedicine-adoption/
• Tingle C. Women found more likely to utilize telehealth vs men. Healio . 2020. Available from: https://www.healio.com/news/orthopedics/20201207/women-found-more-likely-to-utilize-telehealth-vs-men
• Escoffery C. Gender similarities and differences for e-health behaviors among U.S. adults. Telemed E-Health . 2018;24(5):335–43.
• Scott Kruse C, Karem P, Shifflett K, Vegi L, Ravi K, Brooks M. Evaluating barriers to adopting telemedicine worldwide: A systematic review. J Telemed Telecare . 2016;24(1):4–12.
• van Deursen A, van Dijk J. Internet skills performance tests: Are people ready for eHealth?. J Med Internet Res . 2011;13(2):e35.
• Malhotra P, Ramachandran A, Chauhan R, Soni D, Garg N. Assessment of knowledge, perception, and willingness of using telemedicine among medical and allied healthcare students studying in private institutions. TMT . Available from: https://telehealthandmedicinetoday.com/index.php/journal/article/view/228
• Albarrak A, Mohammed R, Almarshoud N, et al. Assessment of physician’s knowledge, perception and willingness of telemedicine in Riyadh region, Saudi Arabia. J Infect and Public Health . 2021;14(1):97–102.
• Dey I, Bhattacharya S. Knowledge and perception of telemedicine among post graduate students of a tertiary hospital of West Bengal. IOSR-JDM . 2016;15(6):8–11.
• Kumar S, McNeil T. Acceptance of neurology telemedicine technology in emergency department. CTBEB . 2017;4(4).
• Acharya R, Rai J. Evaluation of patient and doctor perception toward the use of telemedicine in Apollo Tele Health Services, India. J Fam Med Prim Care . 2016;5(4):798.
• Bali S. Barriers to development of telemedicine in developing countries. Telehealth . 2018. Available from: https://www.intechopen.com/chapters/64650 . doi:10.5772/intechopen.81723
• PwC. PwC publishes results of global survey on technology, jobs and skills. PwC . 2019. Available from: https://www.pwc.com/gx/en/news-room/press-releases/2019/global-skills-survey-2019.html
• American Well. Telehealth index: 2019 Consumer survey [Internet]. Amwell. 2020. Available from: https://business.amwell.com/resources/telehealth-index-2019-consumer-survey/
• Haluza D, Wernhart A. Does gender matter? Exploring perceptions regarding health technologies among employees and students at a medical university. Int J Med Inform . 2019;130:103948.
• Park S, Nam M, Cha S. University students' behavioral intention to use mobile learning: Evaluating the technology acceptance model. Br J Educ Technol . 2012 Jul;43(4):592–605.
• Granić A, Marangunić N. Technology acceptance model in educational context: A systematic literature review. Br J Educ Technol . 2019 Sep;50(5):2572–93.
• Li Q. Healthcare at your fingertips: The acceptance and adoption of mobile medical treatment services among Chinese users. Int J Environ Res Public Health . 2020 Jan;17(18):6895.
• Valikodath N, Leveque T, Wang S, Lee P, Newman-Casey P, Hansen S, et al. Patient attitudes toward telemedicine for diabetic retinopathy. Telemed E-Health . 2017;23(3):205–12.
• Patel K. Assessment of Knowledge, attitude, perception of pharmacy students towards telepharmacy. Applied Research Projects [Internet]. 2021 Apr 20;75. doi: 10.21007/chp.hiim.0072
• Russo L, Campagna I, Ferretti B, Agricola E, Pandolfi E, Carloni E, et al. What drives attitude towards telemedicine among families of pediatric patients? A survey. BMC Pediatrics . 2017;17(1).
• Rho M, Choi I, Lee J. Predictive factors of telemedicine service acceptance and behavioral intention of physicians. Int J Med Inform . 2014;83(8):559–71.

Table 1: Summary of the Socio-demographic Characteristics of Survey Respondents

Table 2: Summary Statistics of Knowledge, Attitudes and Perceptions towards Telemedicine of Survey Respondents

Table 3: Summary Mean Scores of Knowledge, Attitudes and Perceptions Towards Telemedicine of Survey Respondents per Socio-demographic Variable

Table 4: Correlation of Knowledge, Attitudes and Perceptions Towards Telemedicine

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Citation for this article:

• Introduction
• Conclusions
• Article Information

χ 2 -Tests were used to test the difference in each reason why telemedicine visits were chosen by telemedicine mode.

The P value from the χ 2 -test assessing the difference in primary reason for most recent telemedicine visit by telemedicine mode was P  = .008. There were statistically significant differences between the observed and expected frequencies based on adjusted residuals for all audio-only and any video telemedicine visit values.

Supporting data are available in eTable 3 in Supplement 1 . χ 2 Tests were used to test the difference in each experience with telemedicine visit by telemedicine mode.

a Statistically significant difference (Bonferroni adjusted P  <.05) by telemedicine mode.

eTable 1. Health Information National Trends Survey 6 Questions, 2022

eTable 2. Telemedicine Visits and Mode by Patient Characteristics Among Adults With a Health Care Visit in the Past 12 Months, 2022

eTable 3. Reasons For and Experiences Using Telemedicine by Telemedicine Mode, Among Adults With a Health Care Visit and a Telemedicine Visit in the Past 12 Months, 2022

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Chang E , Penfold RB , Berkman ND. Patient Characteristics and Telemedicine Use in the US, 2022. JAMA Netw Open. 2024;7(3):e243354. doi:10.1001/jamanetworkopen.2024.3354

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Patient Characteristics and Telemedicine Use in the US, 2022

• 1 Advocate Aurora Research Institute, Advocate Health, Milwaukee, Wisconsin
• 2 Kaiser Permanente Washington Health Research Institute, Seattle
• 3 RTI International, Research Triangle Park, North Carolina

Question   Which patients used telemedicine after in-person visits became more available post–COVID-19 restrictions?

Findings   In this cross-sectional study of 5437 US adults with health care visits in 2022, 43% used telemedicine (70% video visits; 30% audio-only visits). Patients who used telemedicine were more likely to have more health care needs while video telemedicine visits were less likely among older patients and those without internet; no differences were observed by education, race and ethnicity, or income.

Meaning   These findings suggest that while many patients chose to use telemedicine when in-person visits are available, telemedicine access, particularly video visits, was less likely among key populations who experience barriers to accessing care.

Importance   Telemedicine use was common during the COVID-19 pandemic, expanding many patients’ approaches to accessing health care. Of concern is whether telemedicine access was poorer among higher-needs and disadvantaged populations.

Objective   To assess patient characteristics associated with telemedicine use and telemedicine mode and describe telemedicine visit experiences by telemedicine mode.

Design, Setting, and Participants   This cross-sectional study included data from the 2022 Health Information National Trends Survey and included US adults with a health care visit. Data were analyzed from May to September 2023.

Exposure   Patient characteristics.

Main Outcomes and Measures   Any telemedicine visits vs in-person visits only; telemedicine mode (video vs audio-only). Multivariable logistic models assessed patient characteristics associated with telemedicine visits and mode. Bivariate analyses compared telemedicine experiences by mode.

Results   The study included 5437 adult patients (mean [SE] age, 49.4 [0.23] years; 3136 females [53.4%]; 1928 males [46.6%]). In 2022, 2384 patients (43%) had a telemedicine visit; 1565 (70%) had a video visit while 819 (30%) had an audio-only visit. In multivariable models, older age (≥75 years: adjusted odds ratio [aOR], 0.63; 95% CI, 0.42-0.94), no internet use (aOR, 0.62; 95% CI, 0.48-0.81), and living in the Midwest (aOR, 0.50; 95% CI, 0.35-0.70) were negatively associated with having telemedicine visits. Female sex (aOR, 1.43; 95% CI, 1.12-1.83), having chronic conditions (aOR, 2.13; 95% CI, 1.66-2.73), and multiple health care visits (2-4 visits: aOR, 1.77; 95% CI, 1.23-2.54; ≥5 visits: aOR, 3.29; 95% CI, 2.20-4.92) were positively associated. Among individuals who used telemedicine, older age (65-74 years: aOR, 2.13; 95% CI, 1.09-4.14; ≥75 years: aOR, 3.58; 95% CI, 1.60-8.00), no health insurance (aOR, 2.84; 95% CI, 1.42-5.67), and no internet use (aOR, 2.11; 95% CI, 1.18-3.78) were positively associated with having audio-only visits. We observed no significant differences in telemedicine use or mode by education, race and ethnicity, or income. Patients’ experiences using telemedicine were generally similar for video and audio-only except more individuals who used audio-only had privacy concerns (20% vs 12%, P  = .02).

Conclusions and Relevance   In this cross-sectional study of adults with health care visits, many patients, including those with the greatest care needs, chose telemedicine even after in-person visits were available. These findings support continuing this care delivery approach as an option valued by patients. Differences were not observed by most common measures of socioeconomic status. Continued monitoring of telemedicine use is needed to ensure equitable access to health care innovations.

During the COVID-19 pandemic, telemedicine emerged as an important approach for delivering health care. Telemedicine use increased rapidly after COVID-19 was declared a public health emergency. 1 Overall outpatient service rates were able to rebound quickly, largely due to the shift from in-person to telemedicine visits; approximately 50% of visits were through telemedicine during the pandemic’s peak in April 2020. 1 - 3 While telemedicine visits have since declined, recent estimates suggest steady use. In 2021 and 2022, 20% to 39% of adults had telemedicine health care encounters. 4 , 5

Several studies have shown patient willingness and desire to use video telemedicine; between 36% to 67% of patients would like to seek care using telemedicine in the future. 6 - 9 Despite patients’ continued interest in telemedicine, equitable access remains a concern. 9 - 16 Telemedicine offers the promise of improving access by removing financial and logistical barriers associated with transportation, work coverage, and childcare. 15 However, limited access to the technology (particularly for video visits) and other internet-based services risks widening gaps in health care access rather than narrowing them. Several studies from early in the COVID-19 pandemic found less use of telemedicine visits and in fewer video telemedicine visits (than audio-only visits) among patients who were low-income, non-English–speaking, and older age. 12 , 13 , 16 - 20 To our knowledge, few studies have examined how telemedicine use, and its modalities, has evolved. 5

If telemedicine is to remain a common and important approach to health care delivery, it is necessary to understand who is using the technology successfully and why, and, conversely, uncover barriers in access. Using a nationally representative survey, our objective was to assess telemedicine use and modality among adults who had a health care visit in 2022. We compared differences in patient characteristics associated with having any telemedicine visits vs having an in-person visit only. Then, among telemedicine patients, we identified characteristics associated with having video visits compared with only audio visits. Finally, we examined whether the reasons for and experiences of using telemedicine differed by telemedicine mode.

The Advocate Aurora Health institutional review board determined that study was not human participant research, and thus informed consent was not required. This cross-sectional study followed the Strengthening the Reporting of Observational Studies in Epidemiology ( STROBE ) reporting guideline. 21

This cross-sectional study used data from the 2022 Health Information National Trends Survey (HINTS), a nationally representative self-report survey of noninstitutionalized, civilian adults administered by the National Cancer Institute. The survey is administered multimodally, using both paper and web-based surveys. Households that were potentially Spanish speaking received materials in English and Spanish while other households were able to request a Spanish survey. HINTS uses survey weights to obtain a nationally representative sample of US adults and to account for nonresponse bias. Data were collected between March 7 and November 8, 2022. The overall response rate was 28.1%. 22 This study was restricted to adults who had a health care visit in the past 12 months (5437 of 6252 individuals, weighted 86% of adults) to focus on experiences using the health care system.

We measured any telemedicine use (vs only in-person visits) using the question “In the past 12 months, did you receive care from a doctor or health professional using telehealth?” The survey defined telehealth as a “a telephone or video appointment with a doctor or health professional”; it is often referred to as telemedicine. We categorized respondents who answered yes by video, phone call, or both as having had any telemedicine visits, while others were categorized as having in-person visits only. Among individuals who used telemedicine, we categorized those who responded yes by video (or by both video and phone) as having video visits and those who responded yes by phone as having audio-only visits. Those who had telemedicine visits may have also had in-person visits; this was not captured by the survey.

Individuals who used telemedicine were asked 3 questions capturing reasons for using telemedicine and experiences. First, they were asked why they chose a telemedicine visit (yes or no to each): clinician recommendation or requirement, advice on needing in-person care, to avoid infection, convenience, and/or to include others in the appointment. Second, they were asked the primary reason for their most recent telemedicine visit: annual visit; minor illness or acute care; chronic disease management; medical emergency; mental health, behavioral, or substance abuse issues; or other. Finally, they were asked whether they experienced technical problems, whether telemedicine care received was as good as an in-person visit, and if they had privacy concerns regarding their visit. These questions used a 4-point Likert response scale, which we dichotomized based on agreement and disagreement with the statement. Full questions and response options are available in eTable 1 in Supplement 1 .

Patient characteristics included age, sex, race and ethnicity (Hispanic, non-Hispanic Asian, non-Hispanic Black, non-Hispanic White, or non-Hispanic other [including American Indian or Alaska Native, Other Pacific Islander, or multiple races]), education, marital status, household income, insurance, health status, number of chronic conditions, number of health care visits, and internet use. Living in a linguistically isolated area, urbanicity, and census region were also included.

We used descriptive statistics and χ 2 tests to understand differences in characteristics by telemedicine use and telemedicine mode. We also used χ 2 tests to test differences in reasons for using telemedicine and experiences by telemedicine mode. We used the Bonferroni correction to adjust for multiple comparisons and calculated standardized Pearson residuals where needed.

We conducted 2 analyses using multivariable logistic regression models. First, we assessed differences in characteristics of telemedicine and patients who used only in-person visits. Second, we focused on telemedicine patients and compared characteristics of those who only had an audio-only visit with those who had a video or both types of telemedicine visits. Model goodness-of-fit was confirmed with the area under the receiver operating characteristic curve (which determines the model’s ability to discriminate success and failure), the link test (which determines that the model is properly specified if the prediction squared has no explanatory power), 23 and the Archer-Lemeshow test (the Hosmer-Lemeshow test adapted for complex survey samples; whether the fitted model describes the observed data). 24 Weighted missing percentage for sex (5.6%), race or ethnicity (8.2%), education (5.5%), marital status (5.7%), and household income (9.6%) were greater than 5% so we ran models with and without missing as a category. Findings were similar so models without missing categories are presented.

Analyses were conducted using Stata version 17.0 (Stata Corporation). Survey weighting procedures with jackknife replicate weights accounted for the complex survey design; all reported estimates were weighted to represent the US population. Two-sided P  < .05 was considered statistically significant. Data were analyzed from May to September 2023.

The sample of 5437 respondents with a health care visit represented more than 216 million adults nationally. In the final weighted sample, 3136 (53%) identified as female and 1928 (47%) identified as male, with a mean (SE) age of 49.4 (0.23) years.

We found that 2384 patients (43%) reported that 1 or more of their visits in the past 12 months was through telemedicine. A greater percentage of those with any telemedicine visits were female, had poorer health, had more chronic conditions, used the internet, and had more than 5 health care visits ( Table 1 ). Telemedicine use was reported by 50% of patients with multiple chronic conditions (33% with no chronic conditions) and 45% of patients with internet access (31% without internet) (eTable 2 in Supplement 1 ). Telemedicine use was reported more often by patients with multiple visits (2-4 visits: 42%; ≥5 visits: 58%) than those with only 1 visit (28%).

In multivariable analysis ( Table 2 ), having chronic conditions (adjusted odds ratio [aOR], 2.13; 95% CI, 1.66-2.73; P  < .001), multiple health care visits (2-4: aOR, 1.77; 95% CI, 1.23-2.54; P  = .003; ≥5: aOR, 3.29; 95% CI, 2.20-4.92; P  < .001), and female sex (aOR, 1.43; 95% CI, 1.12-1.83; P  = .006) significantly increased the odds of having any telemedicine visits. Conversely, being in the oldest age group (75 years and older: aOR, 0.63; 95% CI, 0.42-0.94; P  = .03), having no internet use (aOR, 0.62; 95% CI, 0.48-0.81; P  < .001), and living in the Midwest (aOR, 0.50; 95% CI, 0.35-0.70; P  < .001) significantly lowered the odds. We did not find significant differences based on education, race and ethnicity, income, urbanicity, and living in a linguistically isolated area.

Among the 2384 individuals who used telemedicine, 1565 (70%) had a video visit while 819 (30%) had an audio-only visit. A greater percentage of patients with audio-only visits were older, were uninsured, and did not use the internet ( Table 1 ). While approximately 40% of both the youngest (351 [41%]) and oldest patients (292 [38%]) reported telemedicine use, only 138 patients (49%) of individuals who used telemedicine aged 75 years and older had a video visit compared with 256 (75%) of individuals who used telemedicine aged 18 to 34 years (eTable 2 in Supplement 1 ).

Multivariable analysis of audio-only vs any video use among individuals who used telemedicine found being in the oldest age groups (aged 65 to 74 years: aOR, 2.13; 95% CI, 1.09-4.14; P  = .03; ≥75 years: aOR, 3.58; 95% CI, 1.60-8.00; P  = .002), being uninsured (aOR, 2.84; 95% CI, 1.42-5.67; P  = .004), and no internet use (aOR, 2.11; 95% CI, 1.18-3.78; P  = .01) were significantly associated with greater odds of just audio-only telemedicine use ( Table 2 ). Similar to the telemedicine use model results, in the modality model, we observed no significant differences by race and ethnicity, education, marital status, income, health status, living in a linguistically isolated area, and urbanicity. Telemedicine mode also did not significantly differ by number of chronic conditions, number of health care visits, or census region.

Individuals who used video and audio-only telemedicine offered similar reasons for choosing a telemedicine visit ( Figure 1 and eTable 3 in Supplement 1 ). The majority of both modes chose telemedicine based on clinician recommendation or requirement (video, 1122 [76%]; audio-only, 497 [67%]) or for convenience (video, 1003 [68%]; audio-only, 424 [60%]). Approximately half wanted to avoid possible infections (1007 [49%]) and almost a third wanted to ask their clinician whether an in-person visit was needed (630 [29%]). More than one-fifth chose telemedicine to include others (446 [22%]).

The goal of the most recent visit was often similar across modes ( Figure 2 and eTable 3 in Supplement 1 ). Most often, patients using telemedicine sought acute care (568 [30%]) or chronic condition management (557 [22%]). Patients who only used audio were more likely than patients using video to have used telemedicine for an annual visit (167 [20%] vs 256 [14%]), while patients using video were more likely than patients who only used audio to have used it for a behavioral health visit (270 [20%] vs 55 [10%]). Only 43 patients (2%) used their recent telemedicine visit for medical emergencies.

When asked about their experience using telemedicine, 25% of both individuals who used video (375) and those who used only audio (188) thought that their telemedicine care was not as good as in-person care, while 461 (19%) reported experiencing technical problems ( Figure 3 and eTable 3 in Supplement 1 ). Patients who only used audio were more likely to be concerned about the privacy of their telemedicine visit than those who used video (126 [20%] vs 200 [12%]; P  = .02).

Telemedicine use remained high in 2022, 2 years after the onset of the COVID-19 pandemic. Our findings showed that the use of telemedicine has persisted beyond the period of COVID-19–related restrictions and many patients chose to use telemedicine even when in-person visits were available. Nationally, more than 40% of adults with a health care visit reported a telemedicine visit. Notably, this estimate of telemedicine use is higher than previously reported, likely because previous estimates included all US adults (37% in 2021, 39% in 2022) 5 , 25 or used a different recall period (4 weeks instead of the 12 months reported here). 4

Similar to previous studies, 5 , 12 - 14 , 18 , 20 , 26 we found having chronic conditions, multiple health care visits, and female sex increased the odds of having any telemedicine visits while older age, no internet use, and living in the Midwest decreased the odds. The findings associated with age and internet use were consistent with concerns associated with a digital divide, positing that younger, wealthier patients were more likely to adopt digital technologies. 27 Conversely, patients with more health needs and/or health care interactions were more likely to use telemedicine. Since the management of numerous chronic conditions using telemedicine has been found to be equivalent to in-person care, 28 health care systems may consider adopting and promoting telemedicine to help clinicians monitor and manage chronic diseases. 29

Notably, 30% of individuals using telemedicine only used audio, suggesting a substantial desire or need for audio-only access. The multivariate analysis examining characteristics associated with telemedicine mode found patients who were uninsured, older, and did not use the internet being more likely to use only audio telemedicine. In addition to also being consistent with the digital divide concerns, greater use of audio-only visits among uninsured patients may be occurring at safety-net organizations like community health centers. 19 , 30 Studies looking at telemedicine use in safety-net organizations have identified both organizational-level barriers (eg, limited IT support, lower operating margins) and patient-level barriers (eg, limited data plans) resulting in greater availability and use of audio-only telemedicine in these settings. 31 , 32

Unlike previous studies examining telemedicine use and mode, 4 , 12 , 13 , 16 , 17 we did not observe differences by race and ethnicity, education, or income. Our findings were consistent with those associated with use of other health technology use. A 2017 study found no differences in portal use by race and ethnicity or in technology barriers (ie, internet use) by socioeconomic status. 33 Like portal use, barriers to video telemedicine may be more likely to be associated with individual differences in knowledge, skills, and comfort using technology rather than technology access. 33 Our findings likely also reflect widespread telemedicine availability resulting from health systems investments in infrastructure and technical support during the COVID-19 pandemic. Future studies will need to continue monitoring these trends to determine if these findings endure.

While other studies have observed greater patient satisfaction among individuals who used video compared with individuals who only used audio, 34 , 35 our findings suggested that the reasons for using telemedicine and user experiences were generally similar across modes. The sole exception was that individuals who used only audio were more likely to have privacy concerns about their telemedicine visit. Audio-only calls may provide patients a greater sense of personal privacy (eg, clinician cannot see patients’ homes) and alleviate concerns with digital data privacy. 31 , 36 , 37 To support continued use of audio-only telemedicine, clinicians and health care systems may consider developing system-level policies that prioritize patient privacy and security, such as ensuring support of existing Health Insurance Portability and Accountability Act regulations across all telehealth platforms and providing recommendations for maintaining personal privacy (eg, headphones). 36 , 37

While the primary reasons for telemedicine visits in both modalities were minor illnesses and chronic disease management, other reasons differed by modality. Like previous studies, we observed a greater percentage of individuals who used only audio reporting an annual visit, potentially because these visits were often provided by clinicians with whom patients have an established relationship. 38 We observed a greater proportion of individuals who used video with a behavioral health visit. The shift to video telemedicine for behavioral health care may reflect the confluence of greater patient willingness to use and comfort with video telemedicine and clinician preference for video care. 9 , 31 Video behavioral health visits offer clinicians much of the same visual information provided through in-person visits, such as nonverbal cues, though video visits have the added advantage of allowing clinicians to view patients’ home environments to tailor their treatments. 31 , 39

Notably, only 25% of both individuals who used video and audio-only telemedicine felt that the care they received via telemedicine was not as good as in-person care. Similarly, Steelfisher et al 9 found that only 33% of individuals who used video telemedicine perceived that the quality of their care was worse compared with in-person visits, largely because of the clinician’s inability to conduct a physical examination. The authors also found that although 90% of clinicians felt their video visits went well, 80% of clinicians would prefer to provide little or no care via telemedicine; 60% of clinicians felt that the quality of care provided by video was worse than in-person care. 9 These findings suggest that clinician preferences to move away from telemedicine may be the largest barrier to receiving care via telemedicine. Future studies will need to better understand how health care system and clinician preferences and concerns contribute to telemedicine use among patients and how visit modality affects care quality and health outcomes. At least in the short run, health care systems may want to focus their efforts on promoting the use of telemedicine for select services, such as chronic condition updates, medication refills, and behavioral health visits that do not require physical examinations. 7 , 9

While video telemedicine is likely to persist, the future of audio-only visits is less certain. The Centers for Medicaid & Medicare Services (CMS) has permanently extended reimbursement for both video and audio-only behavioral health telemedicine visits for Medicare patients, but reimbursement for other telemedicine visits were expected to end after December 2024. 40 Furthermore, reimbursement for audio-only visits were limited to a smaller set of services, including evaluation and management, behavioral health, and education services. 40 , 41 Telemedicine policies affecting patients with Medicaid or commercial insurance coverage vary by state and insurer. 42 Many state and commercial insurers have already started limiting the scope and reach of audio-only telemedicine services. 43 , 44 Given the characteristics of the patients who were more likely to use audio-only services, these restrictions may disproportionately hinder remote access among disadvantaged patient populations (ie, the poor elderly, those lacking access or ability to use the internet, the uninsured). Policies to improve broadband access, including the Emergency Broadband Benefit Program and the Infrastructure Investment and Jobs Act provide $3.2 billion and $65 billion, respectively, will help to improve access to broadband and internet-enabled devices, thus enabling more equitable access to video visits. 42 At the health care system–level, patients could likely benefit from direct assistance in using new technologies, including access to internet-enabled devices and education on using digital health tools effectively. 10

This study has limitations. First, the survey does not allow us to determine whether not using telemedicine is due to availability or patient preference. Second, self-reported survey responses may be subject to recall bias and because the design is cross-sectional, it does not allow us to make causal claims. Third, while the low response rate may raise concerns associated with nonrespondent bias, the sampling and weighting strategy used by HINTS is intended to minimize biases and improve national representativeness and generalizability of the findings. Finally, because of HINTS survey limitations, we could not ascertain whether patients with telemedicine visits also had in-person visits or assess patients’ satisfaction with their in-person visit experiences.

Our study found that 2 years after the onset of the COVID-19 pandemic, telemedicine was still used by over two-fifths of adult patients nationally, notably among patients with greater care needs, suggesting that telemedicine could endure as a satisfactory option in health care delivery. We did not observe differences in telemedicine use or mode by several common measures of socioeconomic status (eg, race and ethnicity, education, income), which may reflect the widespread use of electronic devices and successful national and health care system efforts to maximize telemedicine adoption. However, access to telemedicine, and video visits more specifically, is still less likely among key portions of the population who experience other logistical barriers to accessing care. Continued monitoring of technology improvements, who is using telemedicine, and for what care needs, is needed to support policy makers and health care systems advancing policies and systems that promote access to health care innovations.

Accepted for Publication: January 29, 2024.

Published: March 22, 2024. doi:10.1001/jamanetworkopen.2024.3354

Open Access: This is an open access article distributed under the terms of the CC-BY License . © 2024 Chang E et al. JAMA Network Open .

Corresponding Author: Eva Chang, PhD, MPH, Advocate Aurora Research Institute, Advocate Health, 945 N 12th St, Milwaukee, WI 53233 ( [email protected] ).

Author Contributions: Dr Chang had full access to all of the data in the study and takes responsibility for the integrity of the data and the accuracy of the data analysis.

Concept and design: Chang.

Acquisition, analysis, or interpretation of data: All authors.

Drafting of the manuscript: Chang, Berkman.

Critical review of the manuscript for important intellectual content: All authors.

Statistical analysis: Chang.

Administrative, technical, or material support: Chang.

Conflict of Interest Disclosures: Dr Penfold reported receiving research funding to his institution from SAGE Therapeutics and the Lundbeck Foundation outside the submitted work. No other disclosures were reported.

Data Sharing Statement: See Supplement 2 .

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Totten AM, Hansen RN, Wagner J, et al. Telehealth for Acute and Chronic Care Consultations [Internet]. Rockville (MD): Agency for Healthcare Research and Quality (US); 2019 Apr. (Comparative Effectiveness Review, No. 216.)

Telehealth for Acute and Chronic Care Consultations [Internet].

Implications and conclusions.

Although the literature evaluating telehealth consultations is large, it is not possible to make a global, general statement about the clinical and economic effectiveness of telehealth consultations for several reasons. These include the diversity of settings, clinical topics and outcomes; the limited number of high-quality studies; different approaches to measurement, particularly of costs; and how the perspective may impact the estimation of outcomes. It is possible to conclude it is likely that telehealth is more effective than usual care in several specific situations: Remote intensive care units (ICUs) reduce ICU and in-hospital mortality; emergency medical services access to telehealth reduces mortality in patients having heart attacks; remote consultations in emergency care decrease time from presentation to decision, reducing emergency department ( ED ) time and increasing appropriate transfers and admissions; remote consultations as part of outpatient care improve clinical outcomes in some clinical disciplines and increase access to care in those that have been studied.

For other uses and outcomes the strength of evidence is less definitive. Telehealth consultations may improve inpatient care, emergency stroke care and the management of and satisfaction with outpatient consultations across several specialties. Potential harms or unintended consequences were rarely addressed and future research should address this, if only to confirm they are not significant. Studies of economic outcomes including costs produced mixed results due to major differences in definitions and methods as well as the fact that costs and savings may not accrue to the same organization in an interdependent healthcare system.

Decision models have the potential to build on systematic review results and use evidence in ways that would make it more applicable by tailoring the question, base case, and perspective to the decision maker’s situation. But our experience demonstrates that the literature may not be available to provide all the data needed to fully execute a functioning model for all topics of interest. However, decision modeling can provide some insight by quantifying differences in costs across settings and estimating where savings are likely to accrue in the system. While our exploratory assessment was limited to costs, expansion of this approach could allow more targeted identification of scenarios in which telehealth could improve the range of outcomes including clinical outcomes, access, and cost.

Future research about telehealth consultations needs to be more rigorous if it is to inform policy and practice decisions. Specifically, more studies should include multiple sites, collect information on the context and environment, and consistently measure a more comprehensive range of economic impacts and costs using standard practices.

• Cite this Page Totten AM, Hansen RN, Wagner J, et al. Telehealth for Acute and Chronic Care Consultations [Internet]. Rockville (MD): Agency for Healthcare Research and Quality (US); 2019 Apr. (Comparative Effectiveness Review, No. 216.) Implications and Conclusions.
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• Beyond the Clinic: California's Vet Telemedicine Bill

As California goes, so goes the nation. Time will tell if this popular saying rings true with respect to California’s recent enactment of Assembly Bill 1399 (AB 1399), which allows a veterinarian-client-patient relationship (VCPR) to be established remotely and eliminates California’s traditional minimum standard of in-person examination prior to treatment recommendation and prescription of medications.

The legislation, which became effective on January 1, 2024, progressed despite strong opposition from prominent organizations like the California Veterinary Medical Association, American Veterinary Medical Association, and others. Critics of AB 1399 have voiced concerns about potential diagnostic inaccuracies, cost escalation, ineffective treatment plans, and detrimental delays in diagnoses and therapies through the use of telemedicine under the guidelines set forth in AB 1399.

The bill’s passage even with strong opposition indicates a shift in perception of telemedicine within the veterinary field as a tool to increase access to care in the midst of a veterinarian shortage. The bill’s supporters, including the American Society for the Prevention of Cruelty to Animals, San Diego Humane Society, and Virtual Veterinary Care Association, argue that telemedicine can offer improved care access, especially in rural communities and shelter medicine, and for animals with significant behavioral issues. Supporters also noted California veterinarians would utilize their training, experience and education in appropriate ways that would continue to be overseen by the California Veterinary Medical Board.

Many states relaxed in-person examination requirements when the pandemic made in-person veterinary visits challenging or impossible. While many of the states have since reinstated their in-person examination requirements, California’s AB 1399 instead codifies the previously temporary practice.

AB 1399 was amended numerous times during the legislative season to address concerns and the enacted language incorporates certain measures to address potential risks. These include limiting audio-only communication in establishing a VCPR, restricting telehealth practice to California-licensed individuals, and controlling the prescribing of certain medications via telehealth.

While concerns about the potential risks of telemedicine persist, California’s legislation is a shift in favor of utilization of digital technologies for the practice of veterinary medicine. The debate surrounding telemedicine in the veterinary sphere will continue, with the rest of the country keeping a close eye on California’s successes or failures from AB 1399.

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