Evidence for Telemedicine Efficacy and Quality

The COVID-19 pandemic prompted health care providers and systems to rapidly adopt and expand telemedicine services. Telemedicine provides a safer alternative to in-person visits during the pandemic, but simultaneously introduces multiple decision points for implementation.

While many providers already have telemedicine in place, emerging evidence, policies, and guidance on implementation and maintenance indicate that answers to the question, “how do we implement telehealth equitably, safely, and sustainably?” are very much still evolving. Here, we summarize one of the many components of telemedicine implementation. This is particularly important in safety-net settings that already face challenges related to limited resources and fragmented health information technology.

Quality and Effectiveness. There is a considerable body of evidence supporting the quality and effectiveness of telemedicine interventions and technologies. For many clinical applications, virtual care has been shown to be either equivalent or even better than in-person care in some cases. In particular, there is strong evidence supporting the use of telemedicine for communication, counseling, and remote monitoring of chronic conditions such as cardiovascular and respiratory disease. Virtual care has shown improvements in outcomes such as mortality, quality of life, mental health conditions, and reductions in hospital admissions.

Patient Satisfaction. Telemedicine has also been found to have high patient satisfaction, on par with in-office visits, due to ease of use and improved communication.

Telemedicine to Address Health Equity.Evidence is growing on telemedicine use among diverse and low-income patient populations, including individual and population-level factors associated with telemedicine uptake and satisfaction

  • American Journal of Preventive Medicine: Who Is (And Is Not) Receiving Telemedicine Care During the COVID-19 Pandemic — This research brief examines changes in telehealth use during the COVID-19 pandemic among over 6 million employer-based health plan beneficiaries. The authors found the increase in telemedicine use during the pandemic was greatest among patients in counties with low poverty levels, patients in metropolitan areas, and among adults (as opposed to children). They note the importance of prioritizing outreach to patients whose in-person care is not currently being replaced with telemedicine visits.
Adjusted rates of telemedicine utilization before versus that after the start of the COVID-19 pandemic. Cantor et al. 2021
Primary Care and Behavioral Health Visits per 1000 Patients by Visit Type from February 2019 through August 2020. Uscher-Pines et al. 2021.
Association of Telemedicine Visit Type with Patient- and Zip Code-Level Factors. Rodriguez et al. 2021.
  • Health Affairs: Disparities in Telehealth Use Among California Patients with Limited English Proficiency — This study examines the association between patients’ limited English proficiency (LEP) and telemedicine use (phone and video visits). They also evaluated the impact of telemedicine on healthcare access and use. The authors found that LEP patients had lower rates of telemedicine use compared to proficient English speakers, and that telemedicine use was associated with increased emergency department use for all patients.
  • JAMA Network Open: Patient Characteristics Associated With Choosing a Telemedicine Visit vs Office Visit With the Same Primary Care Clinicians — This article outlines patient characteristics associated with choosing between telemedicine and in-person visits within Kaiser Permanente Northern California. For example, the authors found that choosing telemedicine was associated with in-person visit barriers such as clinic parking costs. They also found that Black patients were more likely to choose telemedicine than other racial/ethnic groups, and patients living in lower socioeconomic status (SES) neighborhoods were more likely to choose telephone visits, but they were less likely to choose video visits than patients in higher SES neighborhoods.