[Skip to Content]
[Skip to Content Landing]

Perceptions and Use of Telehealth Among Mental Health, Primary, and Specialty Care Clinicians During the COVID-19 Pandemic

Educational Objective
To identify the key insights or developments described in this article
1 Credit CME
Key Points

Question  Are clinician perceptions of telehealth quality associated with use?

Findings  In this survey study of 866 mental health (MH), primary care (PC), and specialty care (SC) clinicians, MH clinicians rated the quality of video care the highest and were more likely to prefer video over phone when providing care for patients remotely; PC and SC clinicians were more likely to endorse challenges of video care. Findings aligned with utilization rates, with MH clinicians conducting significantly more video visits than PC and SC clinicians.

Meaning  These findings suggest that specialty-specific differences in clinician perceptions of telehealth were associated with actual use.


Importance  Clinician attitudes toward telehealth may impact utilization rates, and findings may differ based on specialty.

Objective  To determine whether clinician beliefs regarding telehealth quality and ease of use were associated with the proportion of care delivered via video, phone, and in-person across specialties.

Design, Setting, and Participants  This survey study used a voluntary, anonymous survey conducted from August to September 2021 in the Department of Veterans Affairs New England Healthcare System (VANEHS). Mental health (MH), primary care (PC), and specialty care (SC) clinicians were invited to participate. Data were analyzed from October 2021 to January 2022.

Exposures  Participation in a 32-item survey.

Main Outcomes and Measures  The main outcomes were clinicians’ views on relative quality of video, phone, and in-person care; factors contributing to clinicians’ modality choice; telehealth challenges; and clinician modality preferences and utilization when treating new and established patients.

Results  There were 866 survey respondents (estimated 64% response rate); 52 respondents reported no video or phone telehealth use in the 3 months prior to survey completion and were excluded, resulting in a final sample of 814 respondents. Respondents were divided among MH (403 respondents [49.5%]), PC (153 respondents [18.8%]), and SC (258 respondents [31.7%]). Compared with PC and SC clinicians, MH clinicians rated the quality of video care the highest (eg, compared with in-person care with masks when treating new patients: χ2 = 147.8; P < .001) and were more likely to prefer video over phone when treating both new (χ2 = 26.6; P < .001) and established (χ2 = 100.4; P < .001) patients remotely. PC and SC clinicians were more likely to rate phone care as being at least equivalent in quality to video for both new (χ2 = 26.3; P < .001) and established (χ2 = 33.5; P < .001) patients. PC and SC clinicians were also more likely to endorse challenges of video care, including patient barriers and the inability to conduct a physical examination (χ2 = 292.0; P < .001). Most PC and SC clinicians either had no preference (46 PC respondents [36.2%]; 59 SC respondents [28.4%]) or preferred phone (36 PC respondents [28.3%]; 67 SC respondents [32.2%]) for remote care of established patients. Findings aligned with utilization rates within VANEHS, with MH clinicians conducting significantly more of their encounters via video (36 734 encounters [40.3%]) than PC (3201 encounters [3.9%]) and SC (1157 encounters [4.9%]) clinicians.

Conclusions and Relevance  These findings suggest that clinician attitudes regarding telehealth quality and ease of use were associated with utilization rates. Moving forward, clinician use of telehealth may be impacted by additional data regarding the relative effectiveness of modalities as well as improvements in video telehealth workflows.

Sign in to take quiz and track your certificates

Buy This Activity

JN Learning™ is the home for CME and MOC from the JAMA Network. Search by specialty or US state and earn AMA PRA Category 1 Credit(s)™ from articles, audio, Clinical Challenges and more. Learn more about CME/MOC

CME Disclosure Statement: Unless noted, all individuals in control of content reported no relevant financial relationships. If applicable, all relevant financial relationships have been mitigated.

Article Information

Accepted for Publication: April 23, 2022.

Published: June 7, 2022. doi:10.1001/jamanetworkopen.2022.16401

Open Access: This is an open access article distributed under the terms of the CC-BY License. © 2022 Connolly SL et al. JAMA Network Open.

Corresponding Author: Samantha L. Connolly, PhD, Center for Healthcare Organization and Implementation Research, VA Boston Healthcare System, 150 S Huntington Ave, Boston, MA 02130 (samantha.connolly@va.gov).

Author Contributions: Dr. Connolly had full access to all of the data in the study and takes responsibility for the integrity of the data and the accuracy of the data analysis.

Concept and design: All authors.

Acquisition, analysis, or interpretation of data: Connolly, Miller.

Drafting of the manuscript: Connolly.

Critical revision of the manuscript for important intellectual content: All authors.

Statistical analysis: Connolly, Charness.

Obtained funding: Connolly.

Administrative, technical, or material support: Miller, Gifford, Charness.

Supervision: Miller, Gifford.

Conflict of Interest Disclosures: None reported.

Funding/Support: Dr Connolly was supported by grants from the Department of Veterans Affairs, Veterans Health Administration (grant No. VA HSR&D QUE 20-026 and VA HSR&D COR 20-199).

Role of the Funder/Sponsor: The funder had no role in the design and conduct of the study; collection, management, analysis, and interpretation of the data; preparation, review, or approval of the manuscript; and decision to submit the manuscript for publication.

Disclaimer: The content of this study is solely the responsibility of the authors and does not necessarily represent the official views of the US Department of Veterans Affairs or the US Government.

Wosik  J , Fudim  M , Cameron  B ,  et al.  Telehealth transformation: COVID-19 and the rise of virtual care.   J Am Med Inform Assoc. 2020;27(6):957-962. doi:10.1093/jamia/ocaa067PubMedGoogle ScholarCrossref
Heyworth  L , Kirsh  S , Zulman  D , Ferguson  JM , Kizer  KW .  Expanding access through virtual care: the VA’s early experience with COVID-19.   NEJM Catal. 2020;1(4):1-11. doi:10.1056/CAT.20.0327Google Scholar
Patel  SY , Mehrotra  A , Huskamp  HA , Uscher-Pines  L , Ganguli  I , Barnett  ML .  Variation in telemedicine use and outpatient care during the COVID-19 pandemic in the United States.   Health Aff (Millwood). 2021;40(2):349-358. doi:10.1377/hlthaff.2020.01786PubMedGoogle ScholarCrossref
Connolly  SL , Stolzmann  KL , Heyworth  L , Weaver  KR , Bauer  MS , Miller  CJ .  Rapid increase in telemental health within the Department of Veterans Affairs during the COVID-19 pandemic.   Telemed J E Health. 2021;27(4):454-458. doi:10.1089/tmj.2020.0233 PubMedGoogle ScholarCrossref
Jaklevic  MC .  Telephone visits surge during the pandemic, but will they last?   JAMA. 2020;324(16):1593-1595. doi:10.1001/jama.2020.17201PubMedGoogle ScholarCrossref
Rush  KL , Howlett  L , Munro  A , Burton  L .  Videoconference compared to telephone in healthcare delivery: a systematic review.   Int J Med Inform. 2018;118:44-53. doi:10.1016/j.ijmedinf.2018.07.007PubMedGoogle ScholarCrossref
McClellan  MJ , Osbaldiston  R , Wu  R ,  et al.  The effectiveness of telepsychology with veterans: a meta-analysis of services delivered by videoconference and phone.   Psychol Serv. 2021.PubMedGoogle Scholar
Chen  PV , Helm  A , Fletcher  T ,  et al.  Seeing the value of video: a qualitative study on patient preference for using video in a Veteran Affairs telemental health program evaluation.   Telemed Rep. 2021;2(1):156-162. doi:10.1089/tmr.2021.0005Google ScholarCrossref
Ebbert  JO , Ramar  P , Tulledge-Scheitel  SM ,  et al.  Patient preferences for telehealth services in a large multispecialty practice.   J Telemed Telecare. Published online January 18, 2021. doi:10.1177/1357633X20980302 PubMedGoogle ScholarCrossref
Rodriguez  JA , Betancourt  JR , Sequist  TD , Ganguli  I .  Differences in the use of telephone and video telemedicine visits during the COVID-19 pandemic.   Am J Manag Care. 2021;27(1):21-26. doi:10.37765/ajmc.2021.88573PubMedGoogle ScholarCrossref
Cowan  KE , McKean  AJ , Gentry  MT , Hilty  DM .  Barriers to use of telepsychiatry: clinicians as gatekeepers.   Mayo Clin Proc. 2019;94(12):2510-2523. doi:10.1016/j.mayocp.2019.04.018PubMedGoogle ScholarCrossref
Whitten  PS , Mackert  MS .  Addressing telehealth’s foremost barrier: provider as initial gatekeeper.   Int J Technol Assess Health Care. 2005;21(4):517-521. doi:10.1017/S0266462305050725PubMedGoogle ScholarCrossref
Marangunić  N , Granić  A .  Technology acceptance model: a literature review from 1986 to 2013.   Univers Access Inf Soc. 2015;14(1):81-95. doi:10.1007/s10209-014-0348-1Google ScholarCrossref
Connolly  SL , Gifford  AL , Miller  CJ , Bauer  MS , Lehmann  LS , Charness  ME .  Provider perceptions of virtual care during the coronavirus disease 2019 pandemic: a multispecialty survey study.   Med Care. 2021;59(7):646-652. doi:10.1097/MLR.0000000000001562PubMedGoogle ScholarCrossref
Connolly  SL , Miller  CJ , Lindsay  JA , Bauer  MS .  A systematic review of providers’ attitudes toward telemental health via videoconferencing.   Clin Psychol Sci Pract. 2020;27(2):e12311. doi:10.1111/cpsp.12311Google ScholarCrossref
Donaghy  E , Atherton  H , Hammersley  V ,  et al.  Acceptability, benefits, and challenges of video consulting: a qualitative study in primary care.   Br J Gen Pract. 2019;69(686):e586-e594. doi:10.3399/bjgp19X704141PubMedGoogle ScholarCrossref
Vyas  KS , Hambrick  HR , Shakir  A ,  et al.  A systematic review of the use of telemedicine in plastic and reconstructive surgery and dermatology.   Ann Plast Surg. 2017;78(6):736-768. doi:10.1097/SAP.0000000000001044PubMedGoogle ScholarCrossref
Thiyagarajan  A , Grant  C , Griffiths  F , Atherton  H .  Exploring patients’ and clinicians’ experiences of video consultations in primary care: a systematic scoping review.   BJGP Open. 2020;4(1):bjgpopen20X101020. doi:10.3399/bjgpopen20X101020PubMedGoogle ScholarCrossref
Institute of Medicine (US) Committee on Quality of Health Care in America.  Crossing the Quality Chasm: A New Health System for the 21st Century. National Academies Press; 2001.
VA Health Services Research and Development. Corporate Data Warehouse (CDW). Accessed May 3, 2022. https://www.hsrd.research.va.gov/for_researchers/cdw.cfm
Gentry  MT , Puspitasari  AJ , McKean  AJ ,  et al.  Clinician satisfaction with rapid adoption and implementation of telehealth services during the COVID-19 pandemic.   Telemed J E Health. 2021;27(12):1385-1392. doi:10.1089/tmj.2020.0575PubMedGoogle ScholarCrossref
Morland  LA , Mackintosh  MA , Rosen  CS ,  et al.  Telemedicine versus in-person delivery of cognitive processing therapy for women with posttraumatic stress disorder: a randomized noninferiority trial.   Depress Anxiety. 2015;32(11):811-820. doi:10.1002/da.22397PubMedGoogle ScholarCrossref
Acierno  R , Gros  DF , Ruggiero  KJ ,  et al.  Behavioral activation and therapeutic exposure for posttraumatic stress disorder: a noninferiority trial of treatment delivered in person versus home-based telehealth.   Depress Anxiety. 2016;33(5):415-423. doi:10.1002/da.22476PubMedGoogle ScholarCrossref
Egede  LE , Acierno  R , Knapp  RG ,  et al.  Psychotherapy for depression in older veterans via telemedicine: a randomised, open-label, non-inferiority trial.   Lancet Psychiatry. 2015;2(8):693-701. doi:10.1016/S2215-0366(15)00122-4PubMedGoogle ScholarCrossref
Richter  KP , Shireman  TI , Ellerbeck  EF ,  et al.  Comparative and cost effectiveness of telemedicine versus telephone counseling for smoking cessation.   J Med Internet Res. 2015;17(5):e113. doi:10.2196/jmir.3975PubMedGoogle ScholarCrossref
Liebmann  EP , Preacher  KJ , Richter  KP , Cupertino  AP , Catley  D .  Identifying pathways to quitting smoking via telemedicine-delivered care.   Health Psychol. 2019;38(7):638-647. doi:10.1037/hea0000740PubMedGoogle ScholarCrossref
Albritton  J , Ortiz  A , Wines  R ,  et al.  Video teleconferencing for disease prevention, diagnosis, and treatment: a rapid review.   Ann Intern Med. 2022;175(2):256-266. doi:10.7326/M21-3511 PubMedGoogle ScholarCrossref
Saiyed  S , Nguyen  A , Singh  R .  Physician perspective and key satisfaction indicators with rapid telehealth adoption during the coronavirus disease 2019 pandemic.   Telemed J E Health. 2021;27(11):1225-1234. doi:10.1089/tmj.2020.0492PubMedGoogle ScholarCrossref
Kemp  MT , Liesman  DR , Williams  AM ,  et al.  Surgery provider perceptions on telehealth visits during the COVID-19 pandemic: room for improvement.   J Surg Res. 2021;260:300-306. doi:10.1016/j.jss.2020.11.034PubMedGoogle ScholarCrossref
Thomson  AJ , Chapman  CB , Lang  H , Sosin  AN , Curtis  KM .  Outpatient virtual visits and the “right” amount of telehealth going forward.   Telemed J E Health. 2021;27(12):1372-1378. doi:10.1089/tmj.2020.0468PubMedGoogle ScholarCrossref
Benjenk  I , Franzini  L , Roby  D , Chen  J .  Disparities in audio-only telemedicine use among Medicare beneficiaries during the coronavirus disease 2019 pandemic.   Med Care. 2021;59(11):1014-1022. doi:10.1097/MLR.0000000000001631PubMedGoogle ScholarCrossref
Connolly  SL , Stolzmann  KL , Heyworth  L ,  et al.  Patient and provider predictors of telemental health use prior to and during the COVID-19 pandemic within the Department of Veterans Affairs.   Am Psychol. 2022;77(2):249-261. doi:10.1037/amp0000895 PubMedGoogle ScholarCrossref
Rodriguez  JA , Clark  CR , Bates  DW .  Digital health equity as a necessity in the 21st Century Cures Act Era.   JAMA. 2020;323(23):2381-2382. doi:10.1001/jama.2020.7858PubMedGoogle ScholarCrossref
Gray  DM , Joseph  JJ , Olayiwola  JN .  Strategies for digital care of vulnerable patients in a COVID-19 world—keeping in touch.   JAMA Health Forum. 2020;1(6):e200734. doi:10.1001/jamahealthforum.2020.0734Google ScholarCrossref
Chang  JE , Lai  AY , Gupta  A , Nguyen  AM , Berry  CA , Shelley  DR .  Rapid transition to telehealth and the digital divide: implications for primary care access and equity in a post-COVID era.   Milbank Q. 2021;99(2):340-368. doi:10.1111/1468-0009.12509PubMedGoogle ScholarCrossref
Zulman  DM , Wong  EP , Slightam  C ,  et al.  Making connections: nationwide implementation of video telehealth tablets to address access barriers in veterans.   JAMIA Open. 2019;2(3):323-329. doi:10.1093/jamiaopen/ooz024PubMedGoogle ScholarCrossref
Federal Communications Commission. Lifeline program for low-income consumers. Accessed May 3, 2022. https://www.fcc.gov/general/lifeline-program-low-income-consumers
Barnett  ML , Ray  KN , Souza  J , Mehrotra  A .  Trends in telemedicine use in a large commercially insured population, 2005-2017.   JAMA. 2018;320(20):2147-2149. doi:10.1001/jama.2018.12354PubMedGoogle ScholarCrossref
Choi  S , Wilcock  AD , Busch  AB ,  et al.  Association of characteristics of psychiatrists with use of telemental health visits in the Medicare population.   JAMA Psychiatry. 2019;76(6):654-657. doi:10.1001/jamapsychiatry.2019.0052PubMedGoogle ScholarCrossref
Shi  Z , Huskamp  HA , Souza  J , Busch  AB , Uscher-Pines  L , Mehrotra  A .  Characteristics of organizations that provide telemental health.   Healthcare Transformation. Published online December 6, 2019. doi:10.1089/heat.2019.0004Google ScholarCrossref
AMA CME Accreditation Information

Credit Designation Statement: The American Medical Association designates this Journal-based CME activity activity for a maximum of 1.00  AMA PRA Category 1 Credit(s)™. Physicians should claim only the credit commensurate with the extent of their participation in the activity.

Successful completion of this CME activity, which includes participation in the evaluation component, enables the participant to earn up to:

  • 1.00 Medical Knowledge MOC points in the American Board of Internal Medicine's (ABIM) Maintenance of Certification (MOC) program;;
  • 1.00 Self-Assessment points in the American Board of Otolaryngology – Head and Neck Surgery’s (ABOHNS) Continuing Certification program;
  • 1.00 MOC points in the American Board of Pediatrics’ (ABP) Maintenance of Certification (MOC) program;
  • 1.00 Lifelong Learning points in the American Board of Pathology’s (ABPath) Continuing Certification program; and
  • 1.00 credit toward the CME [and Self-Assessment requirements] of the American Board of Surgery’s Continuous Certification program

It is the CME activity provider's responsibility to submit participant completion information to ACCME for the purpose of granting MOC credit.

Want full access to the AMA Ed Hub?
After you sign up for AMA Membership, make sure you sign in or create a Physician account with the AMA in order to access all learning activities on the AMA Ed Hub
Buy this activity
Want full access to the AMA Ed Hub?
After you sign up for AMA Membership, make sure you sign in or create a Physician account with the AMA in order to access all learning activities on the AMA Ed Hub
Buy this activity
With a personal account, you can:
  • Access free activities and track your credits
  • Personalize content alerts
  • Customize your interests
  • Fully personalize your learning experience
Education Center Collection Sign In Modal Right

Name Your Search

Save Search
With a personal account, you can:
  • Access free activities and track your credits
  • Personalize content alerts
  • Customize your interests
  • Fully personalize your learning experience

Lookup An Activity


My Saved Searches

You currently have no searches saved.


My Saved Courses

You currently have no courses saved.