Video versus audio telehealth in safety net clinic patients: Changes by rurality and time

2024  Journal Article

Video versus audio telehealth in safety net clinic patients: Changes by rurality and time

Pub TLDR

The study investigates the use of video versus audio telehealth among low-income safety net clinic patients, focusing on variations by rurality and changes over time. It finds that while telehealth use decreased among urban patients, it remained stable in small rural areas, with audio-only visits being more common overall. The results suggest that eliminating reimbursement for audio telehealth could worsen healthcare inequities.

DOI: 10.1111/jrh.12887    PubMed ID: 39358903
 

College of Health researcher(s)

OSU Profile

Abstract

Background

Understanding the mix of video versus audio telehealth modality is critical to informing care for low-income safety net clinic patients. Our study examined whether telehealth modality and continued use of telehealth varied by rurality and whether that changed over time.

Methods

Encounters from adults in the OCHIN national network of primary care safety net clinics were identified by encounter type (in-person vs telehealth) and telehealth modality (video vs audio) from 4/1/2021 to 3/31/2023. Our main outcome was an interaction between patient rurality (defined using Rural Urban Commuting Area codes) and time. Linear probability models with clinic fixed effects were used to estimate predicted probabilities.

Results

The predicted probability of a telehealth visit decreased from 37.9% to 24.7% among urban patients (P <.001) and remained stable (29.5%-29.8%; P = .82) among patients in small rural areas. By March 2023, telehealth use among patients in small rural areas was 5.1 percentage points higher than among urban patients (P = .02). The predicted probability of an audio-only visit ranged from 63.5% to 70.5% for patients across all levels of rurality, but no significant differences by rurality or time were found.

Conclusions

Safety net clinic patients were more likely to use audio-only than video telehealth visits. Telehealth in urban and large rural areas decreased since the first year of the pandemic. By the end of the study, patients in small rural communities used significantly more telehealth than urban patients. Elimination of reimbursement for audio telehealth visits may exacerbate existing health care inequities.

Larson, A.E., Stange, K.C., Heintzman, J., Zahnd, W., Davis, M., Harvey, S.M.  (2024) Video versus audio telehealth in safety net clinic patients: Changes by rurality and timeThe Journal of Rural Health