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Cover of Use of Telehealth During the COVID-19 Era

Use of Telehealth During the COVID-19 Era

Investigators: , M.D., M.P.H., , M.S., , Ph.D., , B.S., , M.H.I., M.D., Ph.D., , Dr.P.H., , M.P.H., and , Ph.D.

Rockville (MD): Agency for Healthcare Research and Quality (US); .
Report No.: 23-EHC005

Structured Abstract

Objectives:

To assess how to provide telehealth care by identifying characteristics of telehealth delivery, patient populations, settings, benefits and harms, and implementation strategies during the COVID-19 era.

Data sources:

PubMed®, CINAHL®, PsycINFO®, and the Cochrane Central Register of Controlled Trials were searched from March 2020 to May 2022. Additional studies were identified from reference lists and experts.

Review methods:

We included studies that reported characteristics of telehealth use; benefits and harms of telehealth; factors impacting the success of telehealth, including satisfaction/dissatisfaction and barriers/facilitators; and implementation outcomes. We conducted a mixed-methods review, synthesizing quantitative and qualitative studies. Two reviewers independently screened search results for eligibility, serially extracted data, and independently assessed risk of bias of included studies.

Results:

We included 764 studies; 310 studies were included in our syntheses. Patients using telehealth were more likely to be people who are young to middle-aged, female, White, of higher socioeconomic status, and living in urban settings. Visits for mental and behavioral health conditions were more frequent than visits for other conditions, and mental or behavioral care was also more likely to be delivered via telehealth than care for other conditions. Across a variety of conditions, telehealth produced similar clinical outcomes as compared with in-person care. Telehealth care is appropriate for some patients, but more information is necessary to determine the suitability of telehealth for specific patient populations; patients and providers felt that telehealth may be less suitable and less desirable for patients with complex clinical conditions; and some patients perceive telehealth as a barrier to improved health outcomes owing to the absence of a physical exam and challenges in developing rapport and communicating with their care team. There was a lack of evidence addressing implementation cost, penetration, and sustainability of telehealth, and about telehealth implementation at the health system level.

Conclusions:

Whereas telehealth use spiked after the beginning of the pandemic, the characteristics of patients using telehealth follow a pattern similar to that for other healthcare and digital health services. We found that the use of telehealth may be comparable to in-person care across different clinical and process outcomes. Telehealth implementation has addressed the needs of both patients and providers to some extent, even as clinical conditions, patient and provider characteristics, and type of assessment varied. Telehealth has provided a viable alternative mode of care delivery during the pandemic and holds promise for the future.

Contents

Prepared for: Agency for Healthcare Research and Quality, U.S. Department of Health and Human Services, 5600 Fishers Lane, Rockville, MD 20857; www.ahrq.gov Contract No. 75Q80120D00003 Prepared by: Johns Hopkins University Evidence-based Practice Center, Baltimore, MD

Suggested citation:

Hatef E, Wilson RF, Hannum SM, Zhang A, Kharrazi H, Weiner JP, Davis SA, Robinson KA. Use of Telehealth During the COVID-19 Era. Systematic Review. (Prepared by the Johns Hopkins University Evidence-based Practice Center under Contract No. 75Q80120D00003.) AHRQ Publication No. 23-EHC005. Rockville, MD: Agency for Healthcare Research and Quality; January 2023. DOI: https://doi.org/10.23970/AHRQEPCSRCOVIDTELEHEALTH. Posted final reports are located on the Effective Health Care Program search page.

This report is based on research conducted by the Johns Hopkins University Evidence-based Practice Center (EPC) under contract to the Agency for Healthcare Research and Quality (AHRQ), Rockville, MD (Contract No. 75Q80120D00003). The findings and conclusions in this document are those of the authors, who are responsible for its contents; the findings and conclusions do not necessarily represent the views of AHRQ. Therefore, no statement in this report should be construed as an official position of AHRQ or of the U.S. Department of Health and Human Services.

None of the investigators have any affiliations or financial involvement that conflicts with the material presented in this report.

The information in this report is intended to help healthcare decision makers—patients and clinicians, health system leaders, and policymakers, among others—make well-informed decisions and thereby improve the quality of healthcare services. This report is not intended to be a substitute for the application of clinical judgment. Anyone who makes decisions concerning the provision of clinical care should consider this report in the same way as any medical reference and in conjunction with all other pertinent information, i.e., in the context of available resources and circumstances presented by individual patients.

This report is made available to the public under the terms of a licensing agreement between the author and the Agency for Healthcare Research and Quality. Most AHRQ documents are publicly available to use for noncommercial purposes (research, clinical or patient education, quality improvement projects) in the United States, and do not need specific permission to be reprinted and used unless they contain material that is copyrighted by others. Specific written permission is needed for commercial use (reprinting for sale, incorporation into software, incorporation into for-profit training courses) or for use outside of the U.S. If organizational policies require permission to adapt or use these materials, AHRQ will provide such permission in writing.

AHRQ or U.S. Department of Health and Human Services endorsement of any derivative products that may be developed from this report, such as clinical practice guidelines, other quality enhancement tools, or reimbursement or coverage policies, may not be stated or implied.

A representative from AHRQ served as a Contracting Officer’s Representative and reviewed the contract deliverables for adherence to contract requirements and quality. AHRQ did not directly participate in the literature search, determination of study eligibility criteria, data analysis, interpretation of data, or preparation or drafting of this report.

AHRQ appreciates appropriate acknowledgment and citation of its work. Suggested language for acknowledgment: This work was based on an evidence report, Use of Telehealth During COVID-19, by the Evidence-based Practice Center Program at the Agency for Healthcare Research and Quality (AHRQ).