JMIR Publications

ABSTRACT

Background:

The onset of the COVID-19 pandemic led US health systems to rapidly implement telehealth services to connect patients and clinicians. This rapid expansion of telehealth allowed us to explore how a telehealth experience may be best delivered across populations and contexts.

Objective:

We aimed to 1) identify telehealth modality preferences (voice vs. video) among clinicians and the populations they serve and 2) explore barriers to telehealth use from clinician and public perspectives.

Methods:

We conducted two independent, cross-sectional, web-based surveys. United States (US) physicians specializing in internal medicine, psychiatry, urology, orthopedic surgery, or obstetrics/gynecology completed a 23-item survey through SERMO’s research panel. Quotas ensured equal representation across the selected clinical specialties. Adult members of the US general public completed a 26-item survey through Qualtrics’ research panel. Quotas ensured the general public sample approximated the US population on educational attainment, gender, and rural residence.

Results:

We recruited 253 clinician participants and 418 general public participants in September 2020 with survey completion rates of 22% (253/1139) and 93% (418/451), respectively. For the initial encounter, 85% (95% CI 80-89) of clinicians and 51% (95% CI 47-56) of public participants preferred video over voice-only. In multiple logistic regression analyses, members of the public with broadband internet at home were more likely than those without broadband to prefer video over voice-only for a first visit with a new clinician (57% vs. 40%; OR 2.00, 95% CI 1.21-3.30). In an established clinical relationship, 63% (95% CI 57-69) of clinicians and 33% (95% CI 28-38) of the general public preferred video over voice-only when discussing a new clinical problem. For a follow-up visit, only 26% (95% CI 20-32) of clinicians and 28% (95% CI 24-33) of the general public preferred video over voice-only. Clinicians and the general public agree that technology not working properly is their main source of telehealth frustration (35% of clinicians, 28% of public). Other major frustrations include limitations on what content can be included in the visit (main frustration for 33% of clinicians, 25% of the public) and downloading new technology (24% of the public).

Conclusions:

Although telehealth connections with video are increasingly common, important factors are associated with a preference for voice-only telehealth connections. Clinicians prefer video over voice-only connections more than patients do for new clinical relationships and new clinical problems. For follow-up care, both clinicians and the public prefer voice-only telephone visits over video. Barriers to video-enabled telehealth experiences include technology failures, varied technology platforms across providers, and a need for more reliable high-speed internet connection. Voice-only telephone-mediated services can potentially improve healthcare access and experiences in light of these barriers to video-based care.