Telehealth Modality Preferences for Video and Voice-Only Visits Among US Clinicians and the Public: Cross-Sectional,...

The onset of the COVID-19 pandemic led US health systems to rapidly implement telehealth services to connect patients and clinicians. This rapid expansion of telehealth allowed us to explore how a telehealth experience may be best delivered across populations and contexts.

We aimed to identify telehealth modality preferences (voice vs video) among clinicians and the populations they serve and explore the barriers to telehealth use from clinician and public perspectives.

We conducted 2 independent, cross-sectional, web-based surveys. US physicians specializing in internal medicine, psychiatry, urology, orthopedic surgery, or obstetrics and gynecology completed a 23-item survey through Sermo's research panel. Quotas ensured equal representation across the selected clinical specialties. Adult members of the US general public completed a 26-item survey through Qualtrics' research panel. Quotas ensured the general public sample approximated the US population on educational attainment, gender, and rural residence.

We recruited 253 clinician participants and 418 general public participants in September 2020, with survey completion rates of 22% (253/1139) and 93% (418/451), respectively. For the initial encounter, 85% (216/253; 95% CI 80%-89%) of clinicians and 51% (215/418; 95% CI 47%-56%) of public participants preferred video over voice only. In multiple logistic regression analyses, members of the public with broadband internet at home were more likely than those without broadband to prefer video over voice only for a first visit with a new clinician (57% vs 40%; odds ratio 2.09, 95% CI 1.25-3.49). In an established clinical relationship, 63% (160/253; 95% CI 57%-69%) of clinicians and 33% (137/418; 95% CI 28%-38%) of the general public preferred video over voice only when discussing a new clinical problem. For a follow-up visit, only 26% (65/253; 95% CI 20%-32%) of clinicians and 28% (117/418; 95% CI 24%-33%) of the general public preferred video over voice only. Clinicians and the general public agree that technology not working properly is their main source of telehealth frustration (86/249, 35% of clinicians; 62/220, 28% of public with telehealth experience). Other major frustrations include limitations on what content can be included in the visit (main frustration for 83/249, 33% of clinicians; 54/220, 25% of the public) and downloading new technology (52/220, 24% of the public).

Although telehealth connections with video are increasingly common, important factors are associated with a preference for voice-only telehealth connections. Clinicians prefer video over voice-only connections more than patients do for new clinical relationships and new clinical problems. For follow-up care, both clinicians and the public prefer voice-only telephone visits over video. Barriers to video-enabled telehealth experiences include technology failures, varied technology platforms across providers, and a need for more reliable high-speed internet connection. Voice-only telephone-mediated services can potentially improve health care access and experiences in light of these barriers to video-based care.