- 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.
- Across a variety of conditions, telehealth produced similar clinical outcomes as compared with in-person care; 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 the limits of insurance reimbursement.
- Some patients perceive telehealth as a barrier to improved health outcomes owing 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 May 2022. 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 764 studies; 310 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 more information is necessary to determine the suitability of telehealth for specific patient populations; patients and providers felt that telehealth may be less suitable and less desirable for patients with complex clinical conditions; and some patients perceive telehealth as a barrier to improved health outcomes owing 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 pattern similar to that for other healthcare and digital health services. We found that the use of telehealth may be comparable to in-person care across different clinical and process outcomes. 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.
Hatef E, Wilson RF, Hannum SM, Zhang A, Kharrazi H, Weiner JP, Davis SA, Robinson KA. Use of Telehealth During the COVID-19 Era. Systematic Review. (Prepared by the Johns Hopkins University Evidence-based Practice Center under Contract No.75Q80120D00003.) AHRQ Publication No. 23-EHC005. Rockville, MD: Agency for Healthcare Research and Quality; January 2023. DOI: https://doi.org/10.23970/AHRQEPCSRCOVIDTELEHEALTH. Posted final reports are located on the Effective Health Care Program search page.