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

Objective To evaluate patient-reported experiences of telehealth and disparities in access, use, and satisfaction with telehealth during the COVID-19 pandemic.Materials and methods We examined data from the fifth wave of the COVID-19 & Chronic Conditions (C3) study conducted between December 2020 and March 2021.Results 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. 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.Discussion 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.Conclusion 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. Telehealth provided continued access to healthcare during the COVID-19 pandemic. We sought to understand how patients with chronic illness used and experienced telehealth during the pandemic, including self-reported quality and usefulness of telehealth visits, and whether there were patient-differences in telehealth experiences. This study found that most patients who had a recent telehealth visit were typically younger, less healthy (eg, self-reported worse overall health or chronic illness burden), and living below poverty level. Though majority of patients reported high satisfaction and usefulness of telehealth, patients who had lower socioeconomic status, lower education, limited English proficiency, more difficulty understanding health information, and less motivation in participating in their healthcare were more likely to report having poorer quality telehealth. These findings highlight that not all patients find telehealth useful or meaningful and certain patient populations might be more vulnerable to poor-quality telehealth visits. These may be important considerations, as telehealth continues to be a part of the healthcare system postpandemic. We offer potential solutions to address this gap in telehealth use and experiences.