HealthCare Disparities & Patient Satisfaction with Telehealth: Audio-Only vs. Video Telehealth

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HERE IS HOW

Though many people have used remote healthcare for the pandemic, people experiencing healthcare disparities and older adults with co-morbidities have been challenged when using telehealth. Many disadvantaged people don’t have the technology or the digital health literacy to access or benefit from video consultations, forcing them to rely on audio-only telehealth. Recent studies have examined patient preferences regarding audio-only versus video telehealth changes in patient satisfaction with telehealth and associated outcomes. 

The US National Institutes of Health (NIH) identify the following groups as having healthcare disparities: 

• American Indians/Alaska Natives
• Asian Americans
• Black/African Americans
• Hispanics/Latinos
• Native Hawaiians and other Pacific Islanders
• Sexual and gender minorities
• Socioeconomically disadvantaged populations
• Underserved rural populations

Audio-Only Telehealth vs. Video Telehealth in People with Healthcare Disparities

While researching the satisfaction rates in people comprising these several groups is daunting, notable inroads are being made. A recent study in the American Journal of the Medical Sciences highlighted the difference in satisfaction between audio-only telehealth and video visits for medical care, adding fuel to the argument that reimbursement is warranted for both medical and behavioral care. The 2022 study is titled, Satisfaction with modes of telemedicine delivery during COVID-19: A randomized, single-blind, parallel-group, noninferiority trial. It attempted to measure satisfaction among people receiving audio-only telehealth versus video telehealth. Telehealth.org readers may recall that Medicare reimbursement was approved for telephone and video telehealth in early 2022 and will be augmented dramatically in 2023 if the currently proposed Physician Fee Schedule is passed.

Patient Satisfaction with Telehealth Study: Population Selection Criteria

Patients recruited for the study had visited a participating clinic with at least one face-to-face physician visit in the prior 12 months. They were randomized into one of two groups for their next scheduled routine clinical follow-up by audio-only or video telehealth. The study was performed at the University of Alabama at Birmingham. Most of the participants lived in economically disadvantaged areas.

Participants were enrolled from three clinical practices in the neighboring community. The practices were not informed which patients were accepted into the study. Participants were included if they: 

• Were scheduled for a routine in-office, follow up visit
• Were 60 years or older or were a Medicare or Medicaid beneficiary
•  Had videoconferencing capability.

Of the 200 participants, 43% were Black and 68% were women. Telehealth satisfaction scores were high across all respondents. The majority said that their medical concerns were addressed and would recommend a telehealth visit in the future. 

Patient Satisfaction with Telehealth Study: Research Outcomes 

The researchers found that participants considered audio-only telehealth visits to be the same or slightly more satisfactory compared to video telehealth visits. According to the report:

…the visit satisfaction rates we observed with phone-only telemedicine trended slightly higher than those for video visits. This finding may support some tendency in the older Medicare and younger Medicaid population to be more comfortable with phone-only rather than video visits, even among those with video conferencing capability. The overall satisfaction with either modality was high, adding to the argument that reimbursement is warranted of both types of service at least and until the ease of use of videoconferencing by these populations becomes greater.

Audio-Only Telehealth May Hold the Key to Reducing Telehealth Disparities 

The study included participants from socioeconomically disadvantaged populations where telehealth disparities are known to exist and where technological knowledge and hardware may be absent. Audio-only telehealth can offer greater access to regular healthcare evaluations and medication, thereby reducing telehealth disparities in the future. The success of using telephones for telehealth lies in the clinician’s awareness of telephone telehealth best practices and existing, competency-based treatment protocols for telephone telehealth.

Conclusions

Among a group of diverse, established older or underserved patients, the satisfaction rate for telephone-only telehealth was not inferior to video telehealth visits. These and findings from similar studies have changed reimbursement rates for audio-only services delivered to Medicare beneficiaries for behavioral health services. Similar changes can be expected in other areas of healthcare as an increasing amount of positive research and the controversy surrounding some of this research makes its way to practice and policy decision-makers in the future.

Telehealth Video & Telephone Best Practices

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