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 of the basic components of telemedicine implementation for health care system leaders. 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.
- Health Affairs: The Current State Of Telehealth Evidence: A Rapid Review — This review article has recent evidence regarding telehealth’s efficacy in various clinical areas, as well as its impact on health care utilization.
- Diabetes Research and Clinical Practice: Does Telemedicine Improve Treatment Outcomes for Diabetes? A Meta-Analysis of Results from 55 Randomized Controlled Trials — This review article has evidence regarding telemedicine’s effectiveness for diabetes management compared to conventional care. The authors find that telemedicine is more effective in improving diabetes outcomes than conventional care, particularly for type 2 diabetes.
- International Journal of Medical Informatics: Effectiveness of Telemedicine: A Systematic Review of Reviews — This review article has evidence regarding the impacts and costs of telemedicine, including for behavioral conditions. The authors note a continued need for larger, controlled studies of telemedicine interventions, as well as further study of telemedicine’s cost-effectiveness and impact on patient satisfaction.
- Agency for Healthcare Research and Quality: Telehealth: Mapping the Evidence for Patient Outcomes From Systematic Reviews — This evidence map contains 58 systematic reviews on telehealth, which concluded that there is sufficient evidence to support the use and effectiveness of telehealth for specific uses with some types of patients, including: remote patient monitoring for patients with chronic conditions, communications and counseling for patients with chronic conditions, and psychotherapy as part of behavioral health. Further, they find there is emerging evidence to support the use of telehealth for maternal and child health, as well as triage and urgent care. The PDF version is available online here.
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.
- BMJ Open: Telehealth and Patient Satisfaction: A Systematic Review and Narrative Analysis — This review article has evidence on patient satisfaction regarding telehealth effectiveness and efficiency.
- American Journal of Managed Care: Patient and Clinician Experiences with Telehealth for Patient Follow-Up Care — This article about patient and clinician perceptions of virtual video visits compared to office visits found that the majority of patients and clinicians reported no difference in overall quality between visit types.
Telemedicine to Address Health Equity. There is less evidence available on telemedicine use among diverse and low-income patient populations, including individual and population-level factors associated with telemedicine uptake and satisfaction. Some early evidence in these areas is below.
- Journal of the American Medical Informatics Association Open: Making Connections: Nationwide Implementation of Video Telehealth Tablets to Address Access Barriers in Veterans — This article describes a mixed-methods evaluation of a national effort to distribute tablets for video telemedicine care through Veterans Affairs to high-need veterans with care access barriers. The authors outline the reach of the program, patient-characteristics associated with greater or lower levels of tablet use for video visits, implementation barriers, and recommendations for health systems.
- 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.
- Health Affairs: Are State Telehealth Policies Associated with the Use of Telehealth Services Among Underserved Populations? — This article finds that less restrictive state telehealth policies were not associated with increased telehealth use overall or among Medicaid, low-income, and rural populations between 2013-2016, though telehealth use, particularly video visits, grew substantially over that period across all groups. Further, the authors find that even among populations with low telehealth use, including underserved populations, interest in video visits was high. They suggest that new incentives for health care providers and patients, beyond state efforts, may be needed.