Video Visits with Doctor Add Convenience, Risk of Fragmentation
FOR IMMEDIATE RELEASE: Thursday, March 14, 2019
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WASHINGTON, DC — Convenience, not concern about continuity of care, drives people to use live, online telehealth services—a trend that could contribute to fragmentation of care and higher medical costs. That finding, discussed in research by former Robert Graham Center Medical Director Winston Liaw, MD, MPH, highlights the importance of ensuring telehealth services have strong communication links with their users’ physicians.
Liaw’s research, “Disconnected: A survey of users and non-users of telehealth and their use of primary care,”(academic.oup.com) was published in the current issue of the Journal of the American Medical Informatics Association.
Originally a technique that enabled physicians and hospitals to exchange medical information about a patient, telehealth has emerged as a clinical service that allows patients to remotely consult a health professional in real time. Both independent companies and insurance companies now offer some version of telehealth, and much research has focused on the businesses that provide telehealth services. But virtually no research has looked at telehealth from the patient’s perspective.
That’s where Liaw and his research colleagues stepped in. They conducted an online survey of people whose insurance company offered telehealth services and identified three groups of patients: people who registered with and used the telehealth services; people who registered with but did not use the services; and people who had not registered with the service and did not use it. They then surveyed the patients to collect demographic information and to learn their reasons for either using or not using the online services.
Liaw and his colleagues found that registered users cited convenience and enhanced access as the reason for their choice. Nearly half of telehealth users said they could not get a same-day appointment with their doctor and more than a third said their doctor’s office was closed. Patients said online visits also saved time. However, three out of four also said they would have seen an in-person professional if they had not completed the telehealth visit, an indication that “telehealth video visits are often a substitute for in-person visits.”
“By comparison, new patients wait an average of 24 days to see a doctor in-person, spending two hours for the encounter and round-trip travel,” Liaw and his colleagues write. “Taken together, these findings support the conclusion that users of telehealth are attracted to its convenience.”
Their preference could pose a problem, however. Although most live virtual visits are for short-term illness, data indicate telehealth is being used more and more for chronic conditions. Without integrating the information from live virtual visits, telehealth increases the risk for increasing the fragmentation of care, according to Liaw.
“On average, Medicare beneficiaries already see seven physicians at four different practices, leading to duplicate services, conflicting advice, and ultimately inefficiently delivered care,” Liaw and his colleagues write. “To enhance access without sacrificing coordination, telehealth will need to share information with primary care and vice versa. Without adequate sharing, errors can occur, and critical information will not be communicated to others. The benefits of the improved access afforded by telehealth risk being tempered by an increase in fragmentation. While many telehealth companies are identifying ways to integrate virtual care with electronic health records, more can be done to enhance data continuity.”
About the Robert Graham Center
The Robert Graham Center for Policy Studies in Family Medicine and Primary Care works to improve individual and population health by enhancing the delivery of primary care. The Center staff generates and analyzes evidence that brings a family medicine and primary care perspective to health policy deliberations at local, state, and national levels.
Founded in 1999, the Robert Graham Center is an independent research unit affiliated with the American Academy of Family Physicians (AAFP). The information and opinions contained in research from the Center do not necessarily reflect the views or policy of the AAFP.