Study: Low health literacy, poorer neighborhoods associated with audio-only telehealth use

Patients with lower health literacy and those who lived in more socioeconomically disadvantaged neighborhoods were more likely to participate in an audio-only telehealth visit, according to a study published in JAMA Network Open.

Researchers analyzed more than 18,000 scheduled telehealth visits from outpatient clinics that are part of a large health system. The visits happened early in the COVID-19 pandemic, between March and July 2020. They found low health literacy and a higher area deprivation index (ADI) were associated with audio-only visits, and higher ADI was also associated with a higher likelihood of not showing up to the telehealth appointment.

Overall, only 4% of the visits were no-shows, and 8% of completed visits were audio-only. 

WHY IT MATTERS

Similar to previous research, age, insurance status and identifying as Black were also associated with an audio-only visit. 

Researchers noted audio use was important to consider, since some insurers require video for coverage, and there are still questions about quality of audio-only telehealth care. 

“Although barriers such as wireless internet access, technology cost and privacy will require societal changes, healthcare systems should consider ways to improve telehealth access. Previous work has shown that interventions (e.g. a pre-visit telephone call) can improve video telehealth completion,” they wrote.

“Future directions include electronic medical record triggers that identify patients at risk for telehealth failure, study of ADI components, and association of health literacy and patient portal use.”

THE LARGER TREND

Earlier this year, a report by the U.S. Department of Health and Human Services’ Office of the Assistant Secretary for Planning and Evaluation found video-enabled telehealth visits were lower among people of color, adults without a high school degree, people with lower incomes and those without health insurance. 

But another study published this year showed audio visits can be helpful to patients from marginalized groups. However, more resources are still needed, like third-party language interpretation services and private workspaces for personnel. 

Meanwhile, the Office for Civil Rights at HHS recently issued guidance on providing audio-only telehealth while complying with HIPAA. The House passed a bill Wednesday that would extend the telehealth flexibilities under the public health emergency for another two years. The bill includes provisions for audio-only options.