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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.

Abstract

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.

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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.

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