Patient factors associated with telehealth quality and experience among adults with chronic conditions

Abstract

To evaluate patient-reported experiences of telehealth and disparities in access, use, and satisfaction with telehealth during the COVID-19 pandemic. We examined data from the 5th wave of the COVID-19 & Chronic Conditions (C3) study conducted between December 2020 and March 2021. Of the 718 participants, 342 (47.6%) reported having a telehealth visit within the past four months. Participants who had a recent telehealth visit were younger, reported worse overall health and chronic illness burden, and living below poverty level. 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 patient activation (adjusted odds ratio (AOR) 0.19, 95% CI 0.05–0.59) and limited English proficiency (AOR 0.12, 95% CI 0.03–0.47) were less likely to report telehealth as being better than in-person visits; lower patient 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. Most participants reported usefulness and ease of navigating telehealth. Lower socioeconomic status, limited English proficiency, inadequate health literacy, lower educational attainment, and low patient activation are risks for poorer quality telehealth. The COVID pandemic has accelerated the adoption of telehealth, however disparities in access and self-reported visit quality persist. Since telemedicine is here to stay, we identify vulnerable populations and discuss potential solutions to reduce healthcare disparities in telehealth use.