Telehealth offers the promise of expanding access to health care, but its use remains limited among family physicians, some of whom report barriers to greater adoption, according to a recent survey.
Researchers at the Robert Graham Center for Policy Studies in Family Medicine and Primary Care surveyed family physicians to find out how they are using telehealth services and what obstacles stood in the way of expanding use of those services. Results were published in an article(www.jabfm.org) titled "Family Physicians Report Considerable Interest in, but Limited Use of, Telehealth Services" in the May-June issue of the Journal of the American Board of Family Medicine.
"As telehealth technological capabilities improve and the demand for accessible health care services increases, telehealth represents an important venue to meet the needs of patients," the researchers wrote.
The researchers defined telehealth broadly as the electronic exchange of medical information to improve a patient's health, including the use of live interactive video to provide care or consult with a subspecialist. To their knowledge, theirs was the first in-depth assessment of telehealth use in primary care drawing on a nationally representative sample.
Only 15 percent of the 1,557 family physician respondents said they used telehealth services during 2014, and many of those who used the technology did so infrequently, with 22 percent of them reporting that they used it only once or twice during the year, and 26 percent reporting three to five instances of use.
Among telehealth users, 55 percent used the technology for diagnosis or treatment. Other uses respondents cited included chronic disease management (26 percent), followup (21 percent), obtaining second opinions (20 percent) and emergency care (16 percent).
"While evidence does show that advances have been made in the use of telehealth in primary care settings, little is known about the penetration of the use of various telehealth methods," the researchers wrote.
Researchers identified several situations where patient care can be handled through telehealth services. They noted, for example, that patients could easily use remote blood pressure monitoring units and that those with depression considered telepsychotherapy sessions to be acceptable.
Researchers found that physicians who used telehealth services were more likely to be located in a rural setting, to use electronic health records and to work in a practice with no more than six family physicians. They also were less likely to work in a privately owned practice.
Previous surveys have focused on whether and how often physicians used telehealth services, whereas the Graham Center researchers delved deeper into the types of services the technology is used for and barriers to greater adoption.
When asked what discourages use of telehealth services, both users and nonusers cited lack of training and reimbursement as the main barriers. Family physicians in private practice were more likely to say reimbursement was a barrier than those in integrated health systems. Female physicians were more likely to cite lack of training as a barrier.
To overcome barriers to greater use, the researchers suggest that family medicine residencies ensure that graduating residents have opportunities to use telehealth services. In addition, both public and private insurers should consider expanding the number of telehealth services that are eligible for payment.
"Many impediments to wider adoption exist; however, many of these barriers are amenable to policy modiﬁcations," the researchers concluded.
Related AAFP News Coverage
Robert Graham Center Research
Low Use of Telehealth Tied to Flawed Payment Models