- Telehealth may improve access to care; however, patients using telehealth during the COVID-19 era are, like before COVID-19, more likely to be people who are young to middle-aged, female, White, of higher socioeconomic status, and living in urban settings.
- Differences in clinical outcomes, when seen, were generally small and not clinically meaningful when comparing in-person with telehealth care.
- Telehealth may be less suitable and less desirable for patients with complex clinical conditions, those needing physical exams, and for therapies requiring the development of rapport between patients and providers.
- Providers note that the cost of telehealth can be a barrier to care owing to limits to insurance reimbursement.
- Some patients perceive telehealth as a barrier to improved health outcomes due to the absence of a physical exam and challenges in developing rapport and communicating with their care team, potentially resulting in delayed or missed diagnoses.
Objectives. To assess how to provide telehealth care by identifying characteristics of telehealth delivery, patient populations, settings, benefits and harms, and implementation strategies during the COVID-19 era.
Data sources. PubMed, CINAHL, PsycINFO, and the Cochrane Central Register of Controlled Trials were searched from March 2020 to July 2021 (an updated search will be completed during review of this draft report). Additional studies were identified from reference lists and experts.
Review methods. We included studies that reported characteristics of telehealth use; benefits and harms of telehealth; factors impacting the success of telehealth including satisfaction/dissatisfaction, and barriers/facilitators; and implementation outcomes. We conducted a mixed-methods review, synthesizing quantitative and qualitative studies. Two reviewers independently screened search results for eligibility, serially extracted data, and independently assessed risk of bias of included studies.
Results. We included 351 studies; 186 studies were included in our syntheses. Patients using telehealth were more likely to be people who are young to middle-aged, female, White, of higher socioeconomic status, and living in urban settings. Visits for mental and behavioral health conditions were more frequent than visits for other conditions and mental or behavioral care was also more likely to be delivered via telehealth than care for other conditions. Across a variety of conditions, telehealth produced similar clinical outcomes as compared with in-person care. Telehealth care is appropriate for some patients, but may be less suitable and less desirable for patients with complex clinical conditions; some patients perceive telehealth as a barrier to improved health outcomes due to the absence of a physical exam and challenges in developing rapport and communicating with their care team There was a lack of evidence addressing implementation cost, penetration, and sustainability of telehealth and about telehealth implementation at the health system level.
Conclusions. Whereas telehealth use spiked after the beginning of the pandemic, the characteristics of patients using telehealth follow a similar pattern for other healthcare and digital health services. Telehealth implementation has addressed the needs of both patients and providers, to some extent, even as clinical conditions, patient and provider characteristics, and type of assessment varied. Telehealth has provided a viable alternative mode of care delivery during the pandemic and holds promise for the future.