Disconnected: a survey of users and nonusers of telehealth and their use of primary care. (13th March 2019)

• Record Type: Journal Article
• Authors: Liaw, Winston R; Jetty, Anuradha; Coffman, Megan; Petterson, Stephen; Moore, Miranda A; Sridhar, Gayathri; Gordon, Aliza S; Stephenson, Judith J; Adamson, Wallace; Bazemore, Andrew W
• Is Part Of: Journal of the American Medical Informatics Association. Volume 26:Number 5(2019)
• Page Start: 420
• Page End: 428
• Publication Date: 2019-03-13
• Subjects: telemedicine -- primary health care -- access to health care; Medical informatics -- Periodicals; Information Services -- Periodicals; Medical Informatics -- Periodicals; Médecine -- Informatique -- Périodiques; Informatica; Geneeskunde; Informatique médicale; Computer network resources; Electronic journals; 610.285
• DOI: 10.1093/jamia/ocy182
• Languages: English
• ISSNs: 1067-5027

Abstract

Abstract: Objective: The study sought to assess awareness, perceptions, and value of telehealth in primary care from the perspective of patients. Materials and Methods: We conducted a cross-sectional, Web-based survey of adults with access to telehealth services who visited healthcare providers for any of the 20 most-commonly seen diagnoses during telehealth visits. Three groups were studied: registered users (RUs) of telehealth had completed a LiveHealth Online (a health plan telehealth service provider) visit, registered nonusers (RNUs) registered for LiveHealth Online but had not conducted a visit, and nonregistered nonusers (NRNUs) completed neither step. Results: Of 32 831 patients invited, 3219 (9.8%) responded and 766 met eligibility criteria and completed surveys: 390 (51%) RUs, 117 (15%) RNUs, and 259 (34%) NRNUs. RUs were least likely to have a primary care usual source of care (65.6% vs 78.6% for RNUs vs 80.0% for NRNUs; P < . 001). Nearly half (46.8%) of RUs were unable to get an appointment with their doctor, and 34.8% indicated that their doctor's office was closed. Among the 3 groups, RUs were most likely to be employed (89.5% vs 88.9% vs 82.2%; P = . 007), have post–high school education (94.4% vs 93.2% vs 86.5%; P = . 003), and live in urban areas (81.0% vs 69.2% vs 76.0%; P = . 021). Conclusions: Telehealth users reported that they relied on live video for enhanced access and were less connected to primary care than nonusers were. Telehealth may expand service access but risks further fragmentation of care and undermining of the primary care function absent better coordination and information sharing with usual sources of patients' care.