Majority of Patients Prefer In-Person Visits to Telehealth: Survey

The majority of Americans are willing to do video visits with their doctors for non-emergency care but prefer in-person visits, according to a new study in JAMA Network Open.

When hypothetical out-of-pocket costs are considered, the paper says, people still value in-person care more highly than video encounters. But the choice is fairly cost-sensitive.

The nationally representative survey, conducted by researchers from RAND Corp., asked the respondents about their preferences for telehealth vs. in-person care after the COVID-19 pandemic ends.

The survey panel consisted of 2,080 adults who were given internet-connected devices and were paid for completing the questionnaire. Participants in the weighted sample had an average age of 51, and slightly more than half were women. Minorities were also represented on the panel.

Two-thirds of the participants (66.5%) preferred to have at least some video visits in the future.

But break that down, and an interesting picture emerges: Given a choice between an in-person and a video visit for an encounter that could be handled either way:

53% preferred an in-person visit.
20.9% preferred a video visit.
26.2% didn't have a preference or didn't know.

Forty-five percent of the respondents reported having had one or more video visits since March 2020. Of those in this group:

44.2% preferred an in-person encounter.
31.4% preferred a video visit.
Only 2.3% of these people said they didn't want to do more video visits in the future.

Of the participants without video visit experience, 60.2% preferred an in-person visit and only 12.2% preferred a video visit. The rest didn't have a preference or didn't know.

Younger, wealthier, and better-educated people were more likely to favor video visits. Black respondents had a preference for in-person visits, while Latino participants were more likely to embrace video visits. The racial and ethnic differences were statistically significant. But the differences based on age and income were more significant, says lead author Zachary Predmore, PhD, an associate policy researcher at the RAND Corp.

Young people, he says, are likely to favor video visits because of their knowledge of technology "and growing up in an internet-connected world."

Costs Make a Difference

The survey also asked respondents which type of visit they'd prefer if they had to pay more or less out of pocket for one over the other. Those who expressed a preference for either an in-person or a video visit were asked which option they'd prefer if the copayment for their preferred appointment was $30 and that for the other method was $10. These costs were chosen, the study said, because they represent the lower and upper bounds of typical copayments for outpatient visits.

When in-person visits cost $20 more than video visits, nearly half (49.8%) of respondents who at first preferred telehealth stuck with in-person visits, while 23.5% switched to preferring a video visit, and 26.8% didn't have a preference or didn't know.

When video visits cost $20 more than in-person visits, 18.9% of respondents who at first preferred telehealth still favored video visits, while 61.7% switched to preferring an in-person visit, and 19.1% didn't have a preference or didn't know.

Overall, 47% of respondents were willing to pay for an in-person visit. Just 20.2% of participants said they were willing to pay for a video visit. Twenty-three percent of the sample valued both methods equally and would probably choose whichever option was less expensive, the researchers said.

Why Patients Prefer Office Visits

"There are a couple of possible explanations of why people assign more value to in-person care," Predmore says.

First, he says, is they're used to it. It also seems more comprehensive for visits that require a physical examination or for vital signs to be taken.

For those reasons, he says, "people might put more value on an in-person encounter."

The paper offered several possible explanations for why people might prefer in-person care more than telehealth. One is that patients may like telehealth in certain circumstances (such as acute care for minor conditions) but may not perceive video visits to have the same value as in-person care.

Patients may also perceive that in-person visits allow for easier referrals for diagnostic testing or that even a high-quality telehealth visit can't replicate the in-person interaction with a clinician.

The third of participants who saw no role for video visits in their care tended to be older, poorer, less educated, and more likely to live in rural areas than those who favored a hybrid model of care. Ironically, the authors noted, telehealth could help improve access to care for all of these groups. The survey findings, they said, suggest that "ongoing efforts to promote equity of access to telehealth need to consider these preferences."

While these types of people might have other reasons to prefer in-person care, Predmore said, building out broadband internet access could make a big difference in their choices. "These are closely related but different issues: the willingness to do video visits and the quality of the internet connection. You need to have them both to have a successful telehealth visit."

A key finding of the paper, he said, was that "among those who had used telehealth, there was a very high willingness to do it again. Only 2.3% of those people were unwilling to do it again."

Sources

Zachary Predmore, PhD, associate policy researcher, RAND Corp.

JAMA Network Open: "Patient Preferences for Telehealth Post–COVID-19."

http://click.alerts.jamanetwork.com/click/axac-2h3fzp-pgm1y5-6pvjgmq3/

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