Patient-Reported Experiences with Telehealth During the COVID-19 Pandemic and Beyond

Yoon, Esther S

doi:https://doi.org/10.21985/n2-pbab-w467

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Patient-Reported Experiences with Telehealth During the COVID-19 Pandemic and Beyond

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Objective: To evaluate patient-reported experiences of telehealth and disparities in access, use, and satisfaction with telehealth visits during the COVID-19 pandemic (aim 1), to evaluate prevalence of portal use pre-, peri-, and post-pandemic, among the C3 cohort, and investigate any disparities in use by sociodemographic factors (aim 2), and to explore the telehealth experiences of older adults (age 65+) with multiple chronic conditions in the C3 study, via semi-structured interviews (aim 3). Materials and Methods: The COVID-19 & Chronic Conditions (C3) study is an ongoing, longitudinal, telephone-based survey of participants. For aim 1, we examined data from the 5th wave of the C3 study conducted between December 2020 and March 2021. For aim 2, we conducted a retrospective analysis of the C3 study cohort and examined portal data between January 2019 and December 2022. For aim 3, we conducted semi-structured interviews on a subset of the C3 cohort, targeting patient experiences of telehealth, including barriers and challenges. Results: Aim 1. Of the 718 participants, 342 (47.6%) reported having a telehealth visit within the past 4 months. Participants who had a recent telehealth visit were younger, reported worse overall health and chronic illness burden, and living below poverty level (all P < 0.05). Among participants who had a telehealth visit, 66.7% reported telephone visits and most participants (57.6%) rated telehealth quality as better or equal to in-person visits. Inadequate health literacy was associated with lower likelihood of reporting telehealth quality and usefulness. In multivariable analyses, lower health activation (adjusted odds ratio (AOR) 0.19, 95% CI 0.05 – 0.59) and LEP (AOR 0.12, 95% CI 0.03 – 0.47) were less likely to report telehealth as being better than in-person visits; lower health activation (AOR 0.06, 95% CI 0.003 – 0.41) and income below poverty level (AOR 0.36, 95% CI 0.13 – 0.98) were associated with difficulty remembering telehealth visit information. Aim 2. Median portal logins increased from 16 (0, 277) in 2019 to 31 (0, 256) in 2020. In multivariable analyses, portal login activity was higher during the 3 years of the COVID pandemic (i.e., 2020, 2021, 2022) than the 2019 baseline (all P < 0.001). Portal login activity was also significantly associated with adequate health literacy (IRR 1.51, 95% CI 1.18 – 1.94) and multimorbidity (IRR 1.38, 95% CI 1.17 – 1.64), older age (> 70 years) (IRR 0.69, 95% CI 0.55 – 0.85), female (IRR 0.77, 95% CI 0.66 – 0.91), Hispanic/Latinx (IRR 0.66, 95% CI 0.49 – 0.89), non-Hispanic Black (IRR 0.68, 95% CI 0.56 – 0.83), and Other race (IRR 0.42, 95% CI 0.28 – 0.64). Significant interactions between year and gender (p = 0.004), age (p < 0.001), multimorbidity (p < 0.001), and health literacy (p < 0.001) were found. Aim 3. Many older adults reported an overall positive perspective of telehealth and valued telehealth for its convenience and efficiency, particularly for nonurgent or routine visits. Several factors influenced experiences of telehealth among this population, including the patient’s primary concern or healthcare need, digital literacy, and provider-specific factors, such as rapport and a patient’s desire for human connection. Discussion: Most participants reported high usefulness and ease of navigating telehealth. Lower SES, limited English proficiency, inadequate health literacy, lower educational attainment, and low health activation were risks for poorer quality telehealth visits. Our investigation also illustrated lower portal use among patients who were older, female, racial/ethnic minorities, have lower health literacy, and have lower chronic illness burden. Sociodemographic disparities in portal use by gender, age, multimorbidity, and health literacy shifted over time at different points in the pandemic. The COVID-19 pandemic may have prompted an increase in portal use, thereby reducing sociodemographic disparities, by gender and age. However, the pandemic seems to have widened disparities in portal use among patients with lower health literacy. Qualitative interviews supplemented quantitative findings and highlighted potential ways to improve or optimize telehealth services for this vulnerable population.

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