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Study Shows Physicians and Patients Still Prefer In-Person Care Over Telehealth

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A new study published in Health Affairs reveals that despite telehealth’s rise in popularity during the pandemic, physicians and patients still prefer in-person care

Researchers from Harvard T. H. Chan School of Public Health conducted surveys from February to May 2021. They spoke with primary care physicians and patients who had a video visit with a primary care physician during the pandemic from April to May 2021. In the session, they compared their telehealth experience with in-person care.

Physician and Patient Responses

Of the 337 primary care physicians surveyed, 90% said their pandemic video visits went well. Additionally, patients agreed as 90% of the 1,417 surveyed ranked their most recent video visit similarly. Half of those surveyed also reported that they would have delayed care or not seen a doctor if video visits were not an option.

However, 80% of physicians said they would prefer to provide most care in person after the pandemic. Those that were experiencing significant technological challenges were more likely to express this sentiment. On the other hand, 64% of patients preferred a return to in-person visits. Especially with older patients, those with less education, and those who were Asian more likely to prefer in-person visits.

Reasons for Preference

Older patients tend to have more complex medical problems that are often better addressed in person. However, a lack of access or distrust in virtual platforms may keep 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, suggests that 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.

Physicians should also 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.

Quality Concerns

Among all participants, virtual quality of care concerns centred on the challenges of conducting a physical exam. This includes obtaining accurate vital signs. Technical issues were also common. Instances of poor internet connectivity and audio or video quality affected at least 52% of physicians and 23% of patients.

Patients viewed virtual visits more favourably, with more than half reporting an experience equivalent to in-person appointments. However, just 29% of physicians felt similarly, with 60% saying the video visit quality of care was worse. Most physicians and patients reported that video visits for mental health or triage of COVID-19 symptoms were equivalent to or better than office-based appointments. Still, half of the 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.

Conclusion

While telehealth can offer greater access to care, worries over quality and technical problems may keep video visits from becoming a large portion of primary care. With the COVID-19 public health emergency set to end on 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. The study’s authors suggest that 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. The FY 2023 Omnibus Appropriations bill has already extended some telemedicine capabilities for rural health systems and Medicare beneficiaries. Therefore, this indicates that policymakers understand the importance of telemedicine has come to play in the American medical system.

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