Disparities in patient experience with video and audio-only virtual care

IntroductionThe rapid expansion of virtual ambulatory care has included both video and audio-only modalities. The impact of visit modality on patient experience is poorly understood, particularly in the interplay with social health determinants and technical aspects of virtual care. We sought to characterize differences in the patient-reported experience of virtual care between video and audio-only modalities, and to understand drivers of these differences.MethodsWe analyzed one year of ambulatory virtual visits with linked patient experience data from a US health system. Using nested logistic models, with a patient's likelihood to recommend the provider as the primary outcome, adjusting for patient- and physician-level covariates, we explored differences in experience by visit modality (video vs audio-only), including across demographic groups. We further assessed the impact of modality on patients' experience with technical aspects of virtual care.ResultsAmong 90,670 virtual encounters with patient experience data, 16% were audio-only. Compared with video-based encounters, audio-only visits were associated with lower likelihood to recommend overall (OR 0.75; 95%CI 0.70-0.80) and worse experience with many technical aspects. Black patients were more likely to have audio-only encounters and worse overall patient experience. This disparity persisted after adjusting for visit modality and was partly mediated by differences in perceived respectful provider communication and associated interpersonal aspects of care.DiscussionAudio-only virtual care remains central to ensuring access to care, but poses challenges for patient experience. Interventions and investments targeted at improving technical facets and provider communication are needed, particularly for ensuring equitable experience across racial groups.