Following the COVID-19 pandemic, patient perceptions and preferences of primary care visits in person vs telephone and video were unknown. To better understand if increases in telemedicine visits were linked to the pandemic, Mary Reed, DrPH, and colleagues conducted multiple surveys to “understand the health care experience of patients seeking primary care through telemedicine and how patients expected their preferences to shift as a result of the COVID-19 pandemic.”
Across three time points—before, during, and after the pandemic—researchers reported patients’ general assessment of primary care visits. Although many of the surveyed patients preferred in-person visits before and after the pandemic (69% and 57%), most participants preferred telemedicine visits during the pandemic, with a continued interest at a 12% higher rate post-pandemic.
“Telemedicine does not seem to be going back to prepandemic levels for the foreseeable future,” says Dr. Reed.
Of note, 63% of survey participants said they would utilize telemedicine for some visits, and among the survey participants who reported recent telemedicine visits, 85% felt the visit met their health needs.
The researchers said patients indicated they would continue to prefer telemedicine visits more than before the pandemic.
“For the future of telemedicine, I think our findings are reassuring for the long-term adoption of telemedicine into everyday primary care,” notes Dr. Green.
Improving Addiction Disorder Management
Similarly, a second research team examined the benefits of a form of telemedicine firsthand in a new study for patients with addiction disorders—particularly increased alcohol use.
“Unhealthy alcohol use is common, and the United States Preventive Services Task Force recommends screening all adults for unhealthy alcohol use in primary care,” said lead study author Claire B. Simon, MD. “The AUDIT-C is a practical, widely used three-item screening tool for unhealthy alcohol use which results in a score from 0 to 12 that provides information on a patient’s risk due to drinking.”
There is little known about AUDIT-C reliability in a real-world setting, as most validation studies occurred in research settings.
“Our goal was to evaluate the reliability of the AUDIT-C when used as part of routine care, meaning we were testing whether patients’ scores were the same when they answered the AUDIT-C on two different days less than 21 days apart,” said Dr. Simon. “Since our sample size was large, we were able to evaluate reliability across demographic subgroups defined by age, sex, race, and ethnicity, and across screening modalities—AUDIT-C completed in person on paper forms versus online via a patient portal.”
Dr. Simon’s research team found higher testretest reliability when screenings were completed via the online portal, potentially because completing screenings outside of the clinic reduced hesitancy about reporting drinking to providers.
The team observed a significant difference in test-retest reliability linked with screening modality, so they hypothesized (post hoc) that this difference could be linked to the online screening modality increasing the extent to which patients were comfortable with self-reporting higher levels of alcohol use on healthcare screens. They found that their post hoc analyses supported their hypothesis. Over two screening periods, the initial AUDIT-C screens completed via the online patient portal had higher total scores (M=1.88, SD=1.94) compared with screens completed in-clinic (M=1.61, SD=2.10, P<0.001) and were more often indicative of unhealthy alcohol use (26.8% vs. 22.7%, P<0.001). The researcher reported similar trends during the second screening, with those completed via the online patient portal having higher total scores (M=1.84, SD=2.01) compared with screens completed in-clinic (M=1.59, SD=1.92 P<0.001) and were more often indicative of unhealthy alcohol use (26.4% vs. 22.6% P<0.001).
“Self-administered online screening may be a bit more reliable than screening in clinic on paper forms, but the latter were also very reliable,” explained Dr. Simon. “When feasible, primary care physicians could consider using self-administered portal-based screenings, but paper and pencil works well when screening is not available via an online portal.”
