Telemedicine

Telemedicine—health care delivered virtually by internet or phone—has roots in patient demands for more convenient alternatives to care. However, the COVID-19 pandemic transformed telemedicine into a necessity.

Legislators temporarily loosened regulations for telemedicine in 2020 to help providers continue delivering care despite social distancing regulations. These policy changes drastically changed the landscape of virtual health care. In the first few months of the pandemic, 30 percent of patients used video telehealth, compared with 4 percent in the same period in 2019.

Current research is examining experiences with telemedicine, trends in its use, and its impact on health care services.

RAND work examined the early experience of practicing virtual psychiatry during the pandemic. A year into the pandemic, researchers revisited the appropriateness of telemedicine for psychiatry patients. RAND surveys have found that openness to using telehealth is on the rise, particularly among Black respondents and among patients who can see their own providers. Patients tend to prefer in-person visits, especially if virtual visits are more expensive.

In addition, RAND researchers examined telemedicine use in treating specific populations, including:

• Users of federal safety net clinics in California: Using pandemic-related waivers, safety net medical providers furnished about half of their encounters through audio-only visits. Continued heavy use of the audio-only modality 18 months into the pandemic, however, raised questions of whether many clinics are overly reliant on audio-only telehealth, potentially compromising quality of care relative to in-person visits.
• Opioid use disorder (OUD) patients: Providers pivoted to using telemedicine with the majority of their patients, though some noted the need for more clinical data obtained in person. Many states have implemented some policy changes to facilitate remote OUD treatment, but few states have comprehensively expanded access.
• Service members using the Military Health System: Since the pandemic began, the Military Health System has adapted to offering telehealth, mostly through phone-based visits. Interviewed providers were open to conducting video-based visits, with appropriate guidance and training.
• Breastfeeding mothers: In a randomized controlled trial of remote lactation services, about 45 percent of mothers used video-based telehealth outside of typical business hours to address their question and concerns.
• People in underserved areas: Patients in lower-income zip codes were less likely to use telehealth, in comparison to more affluent patients. In New York City, access to telehealth was limited to providers accepting insurance and service patients who speak English Similarly, children and adolescents in low-income and rural counties were less likely to have access to broadband internet to support telepsychiatry video visits.

As the pandemic comes to a close, researchers will need to continue studying telehealth’s effects on health care costs, outcomes, access, and equity.