After the Pandemic, In-Person Visits Preferred Over Telehealth Visits, Study Finds

In survey data, 80% of primary care physicians and 64% of patients reported they would prefer to conduct future visits in-person rather than via telehealth.

Although most primary care physicians and patients were satisfied with telehealth visits during the coronavirus pandemic, majorities of both populations prefer in-person visits in the future, according to a new research article.

Many in-person medical visits were not possible during the early phase of the pandemic, and telehealth visits increased sharply. The future of telehealth visits after the pandemic is unclear.

The new research article, which was published today by Health Affairs, features survey data collected from 337 primary care physicians and 1,417 patients. The physician survey was conducted from Feb. 12 to May 24, 2021. The patient survey was conducted from April 30 to May 11, 2021.

The study includes several key findings:

• 80% of primary care physicians reported that they would prefer to conduct future patient visits in-person rather than via telehealth
   
• 64% of patients reported that they would prefer to conduct future visits in-person rather than via telehealth
   
• 60% of physicians reported that the quality of telehealth visits was inferior to in-person visits; 29% reported quality was equivalent
   
• 33% of patients reported that the quality of their video visits was inferior to in-person visits; 51% reported quality was equivalent
   
• The most common reason given for lower quality of telehealth visits compared to in-person visits was the lack of a physical examination (92% of physicians and 90% of patients)
   
• 90% physicians and patients reported that telehealth visits went well during the pandemic
   
• 45% of physicians reported rapport was worse by video than by in-person visits
   
• 20% of patients reported rapport was worse by video than by in-person visits
   
• 52% of physicians reported very or somewhat frequent difficulties with video or audio quality, 39% of physicians reported they very or somewhat frequently had Internet connectivity difficulties, and 34% of physicians reported the video platform or software did not work well
   
• Regarding their most recent video visit, 23% of patients reported that they had difficulties with video or audio quality, 17% of patients reported they had Internet connectivity difficulties, and 18% of patients reported that the video platform did not work well
   
• Older patients, patients with lower educational attainment, and Asian patients were more likely than other patients to prefer in-person visits over telehealth visits in the future

"We found that telemedicine was widely accepted and appreciated by patients and physicians early in the COVID-19 pandemic; however, majorities of both groups expressed a preference for in-person visits in the future. … More physicians see the quality of care by video as inferior, with concerns about limitations on physical examinations that are mirrored by patients. Investing in tools that enhance the virtual physical may be beneficial both in their own right and in terms of facilitating virtual care when needed," the study's co-authors wrote.

Interpreting the data

The study suggests a diminished role for telehealth in primary care after the pandemic, the study's co-authors wrote. "Few physicians indicated a preference to continue telemedicine as their main modality of care, although many saw a role for a small share of care provided this way, particularly for mental health. In parallel, few patients would choose a video visit if in-person visits were available. … Results suggest that in the long term, telemedicine can play a role in providing access to care during health emergencies, but it will likely play a smaller role in primary care, at least in the immediate future, with a focus on patients who prefer or need this modality and on specific conditions such as behavioral health."

The quality of care in telehealth visits is a concern for primary care physicians, the co-authors wrote. "Most physicians felt that the quality of care provided by video was generally worse than what they could provide in person, even in a pandemic. That said, perception of quality varied across visit types, with behavioral health seen as largely equivalent. Further, the most common concern about quality was the lack of a physical exam. Together this evidence suggests that perception of quality may vary even within categories such as management of chronic conditions, such that visits for which a physician feels a physical exam is important are the least likely to be seen as high quality in the video setting."

Patients were less concerned about quality of care in telehealth visits, the co-authors wrote. "Results may reflect the fact that patients were evaluating only a single visit and thus made a more neutral judgment in the absence of more experience, or perhaps that they did not face cumulative burdens from video care in the way that physicians may have. Consistent with this idea, for patients, quality of care in the video setting was linked to the appeal of virtual care in the future. Because concerns about quality were connected to not having a physical exam, this reinforces the possibility that some kinds of care are better suited to video care even from the patient's perspective and that improvements to home tools such as blood pressure cuffs could improve perceived or actual quality from the patient side and facilitate willingness to seek virtual care when appropriate."

The study found that there could be concerns about a "digital divide," the co-authors wrote. "What we did find is that older respondents, those with less education, and those who were Asian were less likely to want to continue using video visits. This is consistent with concerns about a 'digital divide' in telemedicine use that favors those who are younger, wealthier, and White, both in the COVID-19 pandemic and more broadly."

Related: Study: Telehealth Doesn't Lead to Excessive Healthcare Use