Variation in Telehealth Use in a National Home Test-to-Treat Program for Acute Respiratory Infections

Area of Science:

• Public Health
• Health Services Research
• Digital Health

Background:

• Home Test-to-Treat (HTTT) programs offer timely antiviral treatment for COVID-19 and influenza via at-home testing and telehealth.
• Traditional access metrics may overlook variations in care delivery timing and modality.
• This study investigates distinct process-based patterns in telehealth access within HTTT programs.

Purpose of the Study:

• To identify and characterize distinct phenotypes of telehealth access within a national Home Test-to-Treat program.
• To analyze variations in encounter timing, modality preference, process duration, and sociodemographic factors.
• To assess the relationship between telehealth access phenotypes and healthcare utilization.

Main Methods:

• Analysis of de-identified encounters from a national HTTT program (September 2023-July 2024).
• K-means clustering of standardized variables to derive patient phenotypes based on access attributes.
• Assessment of symptom duration and healthcare utilization via 10-day surveys.

Main Results:

• Three distinct telehealth access phenotypes were identified: Delayed/Disrupted Access (24.7%), Digitally Engaged but Socioeconomically Vulnerable (23.5%), and Mainstream Access and Efficient Utilization (51.8%).
• Significant differences in mean process duration were observed across phenotypes (p < 0.001).
• The Digitally Engaged group showed lower synchronous preference and higher emergency department visits, while the Delayed/Disrupted group had higher urgent care utilization.

Conclusions:

• Telehealth utilization in HTTT programs forms distinct phenotypes characterized by timing, modality, and efficiency.
• Evaluating healthcare equity necessitates examining the nuances of care delivery, not just its occurrence.
• Findings highlight the importance of tailored approaches to optimize telehealth access and outcomes.