Satisfaction with Telehealth Care in the United States: Cross-Sectional Survey

Abstract

Background:

Telehealth use remains high following the COVID-19 pandemic, but patient satisfaction with telehealth care is unclear.

Methods:

We used cross-sectional data from the Health Information National Trends Survey (HINTS 6). 2,058 English and Spanish-speaking U.S. adults (≥18 years) with a telehealth visit in the 12 months before March–November 2022 were included in this study. The primary outcomes were telehealth visit modality and satisfaction in the 12 months before HINTS 6. We evaluated sociodemographic predictors of telehealth visit modality and satisfaction via Poisson regression. Analyses were weighted according to HINTS standards.

Results:

We included 2,058 participants (48.4 ± 16.8 years; 57% women; 66% White), of which 70% had an audio-video and 30% an audio-only telehealth visit. Adults with an audio-video visit were more likely to have health insurance (adjusted prevalence ratio [aPR]: 1.55, 95% confidence interval [CI]: 1.18–2.04) and have an annual household income of ≥$75,000 (aPR: 1.18, 95% CI: 1.00–1.39) and less likely to be ≥65 years (aPR: 0.79, 95% CI: 0.70–0.89), adjusting for sociodemographic characteristics. No further inequities were noted by telehealth modality. Seventy-five percent of participants felt that their telehealth visits were as good as in-person care. No significant differences in telehealth satisfaction were observed across sociodemographic characteristics, telehealth modality, or the participants' primary reason for their most recent telehealth visit in adjusted analysis.

Conclusions:

Among U.S. adults with a telehealth visit, the majority had an audio-video visit and were satisfied with their care. Telehealth should continue, being offered following COVID-19, as it is uniformly valued by patients.

Introduction

In March of 2020, the Centers for Medicare & Medicaid temporarily expanded telehealth benefits in response to the coronavirus disease 2019 (COVID-19) pandemic, enabling individuals to receive care without having to travel to a health care facility.¹ The use of telehealth, as a means of improving access to and delivering health care, subsequently increased.^1,2 2021 National Health Interview Survey data showed that 37% of adults had a telehealth visit in the 12 months before January–December 2021, during the early stages of COVID-19.² In addition, 2022 Health Information National Trends Survey data showed that 39% of adults had a telehealth visit in the 12 months before March–November 2022, indicating that telehealth use remained high more than a year after telehealth expansion.³ Telehealth includes both synchronous (audio-video and audio-only) visits and asynchronous communication.⁴

The U.S. Census Bureau's Household Pulse Survey data, from July 2021 through August 2022, demonstrated significant disparities in synchronous telehealth modality.⁵ Respondents were less likely to have reported an audio-video telehealth visit if they were aged 65 years and older; were men; identified as Hispanic, Black, or Asian; had less than a Bachelor's degree; had an annual household income of less than $100,000; were uninsured; and lived in the Midwest.⁵ A review of studies published from December 2019 to August 2020, conducted among patients treated by a specific medical specialty (e.g., rheumatology, dermatology), found high satisfaction with telehealth irrespective of telehealth mode (synchronous vs. asynchronous) and disease type.⁶ Furthermore, patients felt that audio-video telehealth visits were as good as in-person visits.^6–10 Also, satisfaction with telehealth care did not vary by age or sex.⁶

A cross-sectional observational study conducted before the onset of COVID-19 (spanning from October 2019 to April 2020) found that, among 8,930 patients who filled out satisfaction surveys after telehealth visits, 93–97% expressed satisfaction with the patient portal, video quality, and provided instructions.¹¹

The temporary expansion of telehealth benefits is expected to end on December 31, 2024.¹² While the aforementioned research provides early evidence that patients are generally satisfied with the care they receive via telehealth,^6–11 certain studies have found that patients reported lower satisfaction levels with telehealth visits in comparison to in-person consultations.^13,14 For example, a cross-sectional study by Acoba et al. revealed that patients with cancer who engaged in telehealth visits reported lower satisfaction than those opting for in-person visits.¹³ Specifically, Asian, Native Hawaiian, and other Pacific Islander patients demonstrated significantly reduced contentment with patient-physician communication during telehealth encounters when compared to White patients.¹³

In a prospective observational study, among pregnant women from rural areas in India, uptake of telemedicine was low and among those women with a teleconsultation about 78% reported being unsatisfied with the visit as compared with in-person care.¹⁴ Satisfaction with telehealth care compared to in-person care post-COVID-19 remains uncertain.

Having a better understanding of the prevalence and predictors of telehealth modality and satisfaction among U.S. adults could aid in decision-making around the continued support of telehealth following the COVID-19 pandemic. To address this, we used 2022 Health Information National Trends Survey (HINTS 6) data to evaluate the prevalence of and sociodemographic predictors of telehealth visit modality and satisfaction in the 12 months before March–November 2022.

Methods

DATA SOURCE AND STUDY POPULATION

This study used publicly available, cross-sectional data from HINTS 6. HINTS is a nationally representative survey, distributed by the National Cancer Institute, of English and Spanish-speaking civilian, noninstitutionalized U.S. adults. HINTS 6 was conducted from March 7 to November 8, 2022.¹⁵ HINTS 6 is the first cycle of the survey to ask questions about telehealth.¹⁵

The sampling strategy for HINTS 6 consisted of a two-stage design.¹⁵ First, a stratified sample of addresses was selected from a database of U.S. residential addresses. Next, one adult was selected within each sampled household to complete the survey.¹⁵ Survey weights were demographically calibrated using 2021 American Community Survey estimates (age, sex, educational attainment, marital status, race, ethnicity, and census region) and HINTS-reported insurance and cancer status.^15,16 We included participants in this study who reported having a telehealth visit in the 12 months before HINTS 6 as well as data on sociodemographic characteristics. This analysis using HINTS data met criteria for nonhuman subjects' research by the Johns Hopkins University School of Medicine Institutional Review Board, thus not requiring review.

OUTCOME MEASURES

To assess telehealth visit modality, all participants were asked: “In the past 12 months, did you receive care from a doctor or health professional using telehealth?.”¹⁷ Response options included (select one): Yes, by video; Yes, by phone call (voice only with no video); Yes, some by video and some by phone call; and No telehealth visits in the past 12 months.¹⁷ For this analysis, response options “Yes, by video” and “Yes, some by video and some by phone call” were grouped as “Audio-Video Telehealth Visit(s)” and “Yes, by phone call (voice only with no video)” was categorized as “Audio-Only Telehealth Visit(s).”

Participants with a telehealth visit in the past 12 months were asked: “In general, how much do you agree or disagree with the following statement regarding your telehealth visit(s)? The care I received through telehealth was as good as a regular in-person visit.”¹⁷ Response options included strongly agree, somewhat agree, somewhat disagree, and strongly disagree.¹⁷ For this analysis, the responses were dichotomized into “satisfied” (strongly agree and somewhat agree) and “dissatisfied” (strongly disagree and somewhat disagree) with their telehealth care.

COVARIATES

Covariates included age, sex, race/ethnicity, education, annual household income, health insurance coverage, marital status, location, census region, and primary reason for respondents most recent telehealth visit. Education was categorized as high school graduate or less, some college/vocational or technical school, or college graduate/postgraduate. Annual household income was categorized as ≤$34,999, $35,000–$74,999, or ≥$75,000. Health insurance was recorded as being covered or not covered by any kind of health insurance plan. Marital status was categorized as married/cohabitating or divorced/widowed/separated/single as a proxy for social support. Location was categorized as urban (metropolitan) or rural (nonmetropolitan). Census region was categorized as Northeast, Midwest, South, or West. The primary reason for respondents most recent telehealth visit was defined as annual visit (yes/no), minor illness/acute care (yes/no), managing chronic condition/disease (yes/no), and mental health, behavioral, or substance abuse issue (yes/no).

STATISTICAL ANALYSIS

Among respondents with a telehealth visit in the past 12 months, we estimated the proportion of U.S. adults with at least one audio-video telehealth visit as well as respondents' satisfaction with their telehealth visit(s). We used recommended methods for HINTS, including survey weights and the delete one jackknife replication method to account for the complex survey design and generate nationally representative estimates.¹⁵ Using generalized linear models with a Poisson distribution and logarithmic link, we examined (1) prevalence ratios (PRs) of sociodemographic predictors of having at least one audio-video telehealth visit in the past 12 months and (2) PRs of sociodemographic and telehealth characteristic predictors of telehealth satisfaction. The telehealth characteristics we examined included telehealth modality and the primary reason for participants' most recent telehealth visit. Analyses were conducted using Stata version 18.0 (StataCorp).

Results

This study included 2,058 participants with a telehealth visit in the past 12 months, of which the mean age was 48.4 years (standard deviation: 16.8), 57% were women, 66% were non-Hispanic White adults, 39% had a college or postgraduate degree, 50% had an annual household income of at least $75,000, 94% had health insurance, 60% were married or cohabitating, 89% lived in an urban location, and 37% lived in the South. Survey-weighted characteristics are provided in Table 1.

Table 1.

Predictors of Audio-Video Telehealth Visits Among Weighted US Adults with a Telehealth Visit in the 12 Months Prior to HINTS 6 (March–November 2022; n = 2,058)

SOCIODEMOGRAPHIC CHARACTERISTICS	US ADULTS WEIGHTED % (95% CI)a	AUDIO-VIDEO TELEHEALTH VISITS WEIGHTED % (95% CI)b	UNADJUSTED PR (95% CI)	ADJUSTED PR (95% CI)c
Overall		70 (67-74)
Age, years
18-44	42 (38-45)	73 (66-79)	1 (Ref)	1 (Ref)
45-64	39 (36-43)	73 (68-77)	1.00 (0.89-1.12)	0.97 (0.86-1.10)
≥65	19 (17-21)	59 (54-64)	0.81 (0.73-0.91)**	0.79 (0.70-0.89)**
Sex
Male	43 (40-46)	70 (64-76)	1 (Ref)	1 (Ref)
Female	57 (54-60)	70 (66-74)	1.00 (0.90-1.11)	1.01 (0.90-1.14)
Race/Ethnicity
NH White	66 (63-69)	72 (67-76)	1 (Ref)	1 (Ref)
NH Black	10 (8-12)	68 (61-75)	0.95 (0.84-1.08)	0.96 (0.85-1.10)
Hispanic	18 (16-20)	66 (60-72)	0.92 (0.82-1.03)	0.96 (0.84-1.08)
NH Asian	6 (4-8)	71 (54-83)	0.98 (0.78-1.23)	0.96 (0.77-1.20)
Education
High School Graduate or Less	24 (21-26)	63 (54-72)	1 (Ref)	1 (Ref)
Some College/Vocational or Technical School	38 (35-41)	71 (66-76)	1.13 (0.97-1.32)	1.07 (0.92-1.25)
College Graduate/Postgraduate	39 (36-41)	74 (71-77)	1.17 (1.01-1.35)*	1.07 (0.90-1.28)
Annual Household Income
≤$34,999	22 (19-26)	61 (55-68)	1 (Ref)	1 (Ref)
$35,000-$74,999	27 (24-31)	69 (63-75)	1.13 (0.98-1.30)	1.12 (0.97-1.30)
≥$75,000	50 (46-54)	75 (70-80)	1.22 (1.07-1.39)*	1.18 (1.00-1.39)*
Health Insurance
No	6 (4-8)	47 (36-58)	1 (Ref)	1 (Ref)
Yes	94 (92-96)	72 (68-75)	1.53 (1.20-1.96)*	1.55 (1.18-2.04)*
Marital Status
Divorced/Widowed/Separated/Single	40 (36-43)	68 (63-72)	1 (Ref)	1 (Ref)
Married/Cohabitating	60 (57-64)	72 (67-76)	1.06 (0.97-1.17)	1.00 (0.91-1.10)
Location
Urban	89 (87-91)	70 (67-73)	1 (Ref)	1 (Ref)
Rural	11 (9-13)	72 (63-79)	1.02 (0.91-1.14)	1.03 (0.91-1.17)
Census Region
Northeast	20 (18-23)	70 (62-76)	1 (Ref)	1 (Ref)
Midwest	15 (13-18)	74 (66-81)	1.06 (0.92-1.24)	1.06 (0.92-1.22)
South	37 (34-40)	72 (65-78)	1.03 (0.89-1.19)	1.06 (0.91-1.21)
West	27 (24-30)	67 (61-73)	0.96 (0.84-1.10)	0.96 (0.85-1.10)

Statistically significant prevalence ratios are in bold.

Weights are calibrated using data from the 2021 American Community Survey (age, sex, educational attainment, marital status, race, ethnicity, and census region) conducted by the U.S. Census Bureau.

^a U.S. adults characteristics are weighted column percentages.

^b Audio-video telehealth visits by sociodemographic characteristics are weighted row percentages.

^c Model adjusting for age, sex, race/ethnicity, education, annual household income, health insurance, marital status, location, and census region

^* p < 0.05; ^**p < 0.001.

aPR, adjusted PR; CI, confidence interval; PR, prevalence ratio.

Among individuals with a telehealth visit in the past 12 months, 70% (95% confidence interval [CI]: 67–74; n = 1,369) reported having at least one audio-video visit (Fig. 1). Individuals reporting at least one audio-video telehealth visit were more likely to be covered by health insurance (covered: 72%; not covered: 47%; adjusted PR [aPR]: 1.55, 95% CI: 1.18–2.04) and have a higher annual household income (≥$75,000: 75%; ≤$34,999: 61%; aPR: 1.18, 95% CI: 1.00–1.39) and less likely to be 65 years and older (18–44 years: 73%; ≥ 65 years: 59%; aPR: 0.79, 95% CI: 0.70–0.89), after adjusting for sociodemographic characteristics (Table 1).

Fig. 1.

Prevalence of audio-video telehealth visits among weighted U.S. adults with a telehealth visit in the 12 months before HINTS 6 (March–November 2022; n = 2,058). Estimates are based on HINTS 6 data fielded from March through November 2022. Question text: “In the past 12 months, did you receive care from a doctor or health professional using telehealth?”.¹⁷ Response options: Yes, by video; Yes, by phone call (voice only with no video); Yes, some by video and some by phone call; and No telehealth visits in the past 12 months.¹⁷ For this analysis, response options “Yes, by video” and “Yes, some by video and some by phone call” were grouped as “Audio-Video Telehealth Visit(s)” and “Yes, by phone call (voice only with no video)” was categorized as “Audio-Only Telehealth Visit(s).” Question asked of all participants; however, only responses indicating that participants had a telehealth visit in the past 12 months were used. CI, confidence interval; HINTS, Health Information National Trends Survey.

Adults with higher educational attainment (college graduate/postgraduate: 74%; high school graduate or less: 63%) were more likely to have had an audio-video telehealth visit in the past year in unadjusted analysis; however, this relationship did not remain after adjusting for other sociodemographic characteristics. No differences were seen in having at least one audio-video visit by sex (males: 70%; females: 70%), race/ethnicity (non-Hispanic White: 72%; non-Hispanic Black: 68%; Hispanic: 66%; non-Hispanic Asian: 71%), marital status (married/cohabitating: 72%; divorced/widowed/separated/single: 68%), location (urban: 70%; rural: 72%), or census region (Northeast: 70%; Midwest: 74%; South: 72%; West: 67%).

Among 1,922 respondents with a telehealth visit in the past year as well as data on the primary reason for their most recent telehealth visit and telehealth modality, 75% (95% CI: 72–79; n = 1,453) reported that they were satisfied with the care they received during their telehealth visit(s) and felt that it was as good as an in-person visit (Fig. 2). No disparities were seen in telehealth satisfaction by sociodemographic characteristics, telehealth modality, or primary reason for their most recent telehealth visit (Table 2). In fact, non-Hispanic Black adults may be more satisfied with telehealth care than non-Hispanic White adults (84% vs. 75%, respectively). However, this relationship was only statistically significant in unadjusted analysis.

Fig. 2.

Prevalence of telehealth care satisfaction among weighted U.S. adults with a telehealth visit in the 12 months before HINTS 6 (March–November 2022; n = 1,922). Estimates are based on HINTS 6 data fielded from March through November 2022. Question text: “In general, how much do you agree or disagree with the following statement regarding your telehealth visit(s)? …The care I received through telehealth was as good as a regular in-person visit.”¹⁷ Response options: “Satisfied” (strongly agree and somewhat agree) and “Dissatisfied” (somewhat disagree and strongly disagree). Question asked of participants who reported having a telehealth visit in the past 12 months.

Table 2.

Predictors of Telehealth Care Satisfaction Among Weighted US Adults with a Telehealth Visit in the 12 Months Prior to HINTS 6 (March–November 2022; n = 1,922)

SOCIODEMOGRAPHIC CHARACTERISTICS	SATISFIED WITH TELEHEALTH CARE WEIGHTED % (95% CI)a	UNADJUSTED PR (95% CI)	MODEL 1 ADJUSTED PR (95% CI)b	MODEL 2 ADJUSTED PR (95% CI)c
Overall	75 (72-79)
Age, years
18-44	73 (66-79)	1 (Ref)	1 (Ref)	1 (Ref)
45-64	78 (73-83)	1.07 (0.95-1.21)	1.04 (0.92-1.19)	1.05 (0.93-1.19)
≥65	75 (69-80)	1.02 (0.90-1.15)	0.99 (0.86-1.13)	0.99 (0.87-1.14)
Sex
Male	72 (65-78)	1 (Ref)	1 (Ref)	1 (Ref)
Female	78 (73-82)	1.08 (0.97-1.21)	1.09 (0.97-1.23)	1.09 (0.97-1.22)
Race/Ethnicity
NH White	75 (71-79)	1 (Ref)	1 (Ref)	1 (Ref)
NH Black	84 (78-89)	1.12 (1.03-1.22)*	1.08 (0.95-1.22)	1.08 (0.95-1.22)
Hispanic	75 (67-82)	1.00 (0.88-1.13)	1.00 (0.85-1.18)	1.01 (0.86-1.19)
NH Asian	66 (48-80)	0.87 (0.68-1.13)	0.89 (0.69-1.14)	0.89 (0.70-1.14)
Education
High School Graduate or Less	78 (68-86)	1 (Ref)	1 (Ref)	1 (Ref)
Some College/Vocational or Technical School	76 (70-82)	0.97 (0.85-1.12)	0.95 (0.83-1.09)	0.96 (0.84-1.10)
College Graduate/Postgraduate	73 (68-77)	0.93 (0.82-1.05)	0.92 (0.81-1.05)	0.93 (0.82-1.05)
Annual Household Income
≤$34,999	78 (68-85)	1 (Ref)	1 (Ref)	1 (Ref)
$35,000-$74,999	74 (67-80)	0.96 (0.83-1.09)	0.98 (0.84-1.15)	0.98 (0.84-1.15)
≥$75,000	75 (70-80)	0.96 (0.84-1.10)	1.01 (0.86-1.17)	1.01 (0.86-1.19)
Health Insurance
No	60 (41-75)	1 (Ref)	1 (Ref)	1 (Ref)
Yes	76 (73-80)	1.28 (0.96-1.72)	1.31 (0.97-1.77)	1.32 (0.97-1.80)
Marital Status
Divorced/Widowed/Separated/Single	75 (68-81)	1 (Ref)	1 (Ref)	1 (Ref)
Married/Cohabitating	76 (72-79)	1.01 (0.92-1.12)	1.01 (0.91-1.12)	1.03 (0.93-1.14)
Location
Urban	76 (72-79)	1 (Ref)	1 (Ref)	1 (Ref)
Rural	75 (63-84)	0.99 (0.85-1.16)	0.96 (0.81-1.15)	0.95 (0.80-1.13)
Census Region
Northeast	70 (61-78)	1 (Ref)	1 (Ref)	1 (Ref)
Midwest	77 (68-85)	1.10 (0.92-1.31)	1.09 (0.91-1.29)	1.10 (0.92-1.31)
South	79 (73-85)	1.13 (0.99-1.30)	1.13 (0.97-1.31)	1.14 (0.98-1.33)
West	73 (65-79)	1.04 (0.90-1.21)	1.05 (0.90-1.22)	1.06 (0.91-1.23)
Telehealth Modality
Audio-Only	75 (68-82)	1 (Ref)	-	1 (Ref)
Audio-Video	75 (71-79)	1.00 (0.89-1.12)	-	0.97 (0.86-1.09)
Annual Visit
No	75 (71-79)	1 (Ref)	-	1 (Ref)
Yes	76 (69-82)	1.01 (0.92-1.12)	-	1.05 (0.92-1.18)
Minor Illness/Acute Care
No	77 (74-81)	1 (Ref)	-	1 (Ref)
Yes	71 (63-79)	0.92 (0.81-1.05)	-	0.96 (0.84-1.10)
Chronic Disease Management
No	75 (71-79)	1 (Ref)	-	1 (Ref)
Yes	77 (68-84)	1.02 (0.90-1.15)	-	1.03 (0.91-1.17)
Mental Health/Substance Abuse
No	74 (70-78)	1 (Ref)	-	1 (Ref)
Yes	82 (70-90)	1.10 (0.97-1.26)	-	1.14 (0.98-1.32)

Statistically significant prevalence ratios are in bold.

Weights are calibrated using data from the 2021 American Community Survey (age, sex, educational attainment, marital status, race, ethnicity, and census region) conducted by the U.S. Census Bureau.

^a Satisfied with telehealth care by sociodemographic characteristics are weighted row percentages.

^b Model 1: adjusting for age, sex, race/ethnicity, education, annual household income, health insurance, marital status, location, and census region.

^c Model 2: adjusting for age, sex, race/ethnicity, education, annual household income, health insurance, marital status, location, census region, telehealth modality, and primary reasons for telehealth visit.

^* p < 0.05; ^**p < 0.001

Satisfaction with telehealth care was similar by age (18–44 years: 73%; 45–64 years: 78%; ≥65 years: 75%), sex (males: 72%; females: 78%), educational attainment (high school graduate or less: 78%; some college: 76%; college graduate/postgraduate: 73%), annual household income (≤$34,999: 78%; $35,000–$74,999: 74%; ≥$75,000: 75%), health insurance status (not covered: 60%; covered: 76%), marital status (married/cohabitating: 76%; divorced/widowed/separated/single: 75%), location (urban: 76%; rural: 75%), and census region (Northeast: 70%; Midwest: 77%; South: 79%; West: 73%). Telehealth care satisfaction was also found to be similar by modality (audio-only: 75%; audio-video: 75%).

Discussion

In this nationally representative sample of adults who reported having a telehealth visit in the 12 months before March–November 2022, we found that 70% had at least one audio-video telehealth visit. Individuals who reported having at least one audio-video telehealth visit were more likely to be covered by health insurance and have a higher annual household income, and less likely to be 65 years and older. No other disparities were noted by telehealth modality. In addition, individuals were largely satisfied with the care they received during their telehealth visit(s) and felt that it was as good as an in-person visit. Compared with non-Hispanic White adults, non-Hispanic Black adults may be more likely to feel that telehealth care is as good as an in-person visit; otherwise, no significant differences were observed across sociodemographic characteristics.

Furthermore, satisfaction with telehealth care did not differ by telehealth modality (audio-video vs. audio-only) or the participants' primary reason for their most recent telehealth visit. Telehealth care is uniformly valued by patients; thus, Congress should continue supporting the expansion of telehealth.

Our findings align with prior studies. For example, the U.S. Census Bureau's Household Pulse Survey data, from July 2021 through August 2022, found that more than half of telehealth users reported having an audio-video telehealth visit during each wave of the survey (ranging from 53% to 60%).⁵ In our study, we observed a higher prevalence of participants having at least one audio-video telehealth visit. It is important to note that HINTS 6 evaluated telehealth use over 12 months, whereas the Household Pulse Survey only assessed it over a shorter period of 4 weeks. Similar to the Household Pulse Survey, we found disparities in telehealth modality by age, annual household income, and insurance coverage.⁵ However, unlike the Household Pulse survey, we did not find disparities in telehealth modality by sex, race/ethnicity, educational attainment, or census region.⁵

Older adults generally have lower digital access and digital literacy than other populations.^18,19 However, older adults may be interested in engaging with digital health technologies if provided the proper support.²⁰ Finding ways to support older adults in using audio-video telehealth, especially for visual assessment for chronic disease management, may be critical to providing quality care. One way of accomplishing this may be to encourage older adults to join audio-video telehealth visits from community spaces (e.g., a public library with private rooms) where they can obtain digital access (internet and computer) and technology support from librarians.^21–23

In this study, we did not find any disparities in telehealth satisfaction by sociodemographic characteristics or telehealth modality. A survey, conducted at a large integrated health system on the west coast of the US from March to December 2020, also found that patients' experience with telehealth was positive.²⁴ However, audio-video telehealth visits were viewed more positively than audio-only telehealth visits and in-person visits.²⁴ Our study also found no differences in telehealth satisfaction based on the primary reasons for participants' most recent telehealth visit, whether it was for an annual examination, minor illness/acute care, managing a chronic condition/disease, or a mental health, behavioral, or substance abuse issue. While the majority of participants engaged in audio-video visits and expressed satisfaction with the care they received, the impact of telehealth utilization and modality on patient outcomes remains unclear. Further research is necessary to explore this question comprehensively across large healthcare systems.

It is important to highlight the advantages and disadvantages of telehealth visits, especially in the digital health era. In a cross-sectional study involving 168 patients from the Department of Dermatology of the George Washington Medical Faculty Associates, who participated in telehealth appointments during the COVID-19 pandemic, several key findings emerged.²⁵ The majority of respondents expressed a preference for telehealth due to its time efficiency (81%), the absence of the need for transportation (74%), and the ability to maintain social distancing (74%).²⁵ On the contrary, the most common reasons for disliking telehealth included a lack of physical touch (27%) and a perception of inadequate assessment (16%).²⁵ Notably, a small percentage of patients indicated reluctance to undertake another telehealth visit (10%) or to recommend telehealth visits to others (7%).²⁵

Similarly, in a cross-sectional study conducted between January and June 2020, 80% of patients who received genetics counseling via telemedicine cited saving travel time as an advantage.²⁶ These patients also reported feeling comfortable communicating with their provider via telemedicine (87%) and that their telemedicine provider was able to understand their medical condition (95%).²⁶ Again, a fairly small percentage of patients reported that they would not want to use telemedicine services again in the future (16%).²⁶

Another crucial topic for discussion is the potential of telemedicine in addressing health disparities, both at the local and global levels. Telemedicine will play a pivotal role in realizing a vision of equitable access to health care for individuals facing challenges in transportation and those with low income. Although the presence of diverse telehealth options may benefit numerous individuals, it is important to recognize that not everyone may be able to take advantage of this care model, especially historically underserved populations, individuals with lower health literacy or educational levels, and older adults.^27,28 Various interconnected and dynamic factors, including device availability, connectivity issues, technological literacy, and comfort considerations, such as privacy concerns, influence challenges in telehealth access and utilization.²⁹ To prevent health disparities, there is a need for policy initiatives focused on ensuring equitable access to telehealth, especially video-audio enabled telehealth.

This study has some limitations that should be considered when interpreting the findings. First, this study used cross-sectional survey data, limiting our ability to determine causation. Second, the response rate for HINTS 6 was low (28%,¹⁵ consistent with declining rates across many national surveys³⁰), indicating the potential for selection bias. However, the survey weighting adjusted for variation in response rates by sociodemographics and other variables. Third, the survey questions asked participants to recall information about their telehealth visits over the prior 12 months, making them subject to recall bias.

Finally, data were not collected on participants' health insurance type. Regardless of these limitations, HINTS 6 is the first national survey study to assess telehealth modality and satisfaction over 12 months, more than a year following the expansion of telemedicine in response to the COVID-19 pandemic.

Conclusions

Among U.S. adults with a telehealth visit in the past 12 months, the use of audio-video visits and telehealth satisfaction was high (70% and 75%, respectively). Individuals with health insurance and a higher annual household income were more likely to have had an audio-video telehealth visit in the past 12 months. Older adults may need additional technology support to use video equipment and engage in audio-video telehealth visits, which may be especially important for chronic disease management. Non-Hispanic Black adults may be more satisfied with telehealth care (i.e., feeling that the telehealth care they received was as good as a regular in-person visit), suggesting that continued use of telehealth in this population may present an opportunity to advance health equity. Otherwise, the use of audio-video telehealth visits and telehealth satisfaction did not differ significantly by other important sociodemographic characteristics.

There may be continued opportunities to leverage telehealth following the COVID-19 pandemic to increase access to care, as it is uniformly valued by patients; however, additional research is needed to evaluate the efficacy of telehealth compared to in-person care in improving patient outcomes.

Authors' Contributions

E.M.S.: conceptualization, formal analysis, visualization, writing—original draft preparation and writing—review and editing; M.F.: conceptualization, formal analysis, and writing—review and editing; Y.C.: conceptualization, writing—original draft preparation, and writing—review and editing; Y.C.-M.: conceptualization and writing—review and editing; C.R.H.: conceptualization and writing—review and editing; S.S.M.: conceptualization and writing—review and editing; J.C.: conceptualization, formal analysis, and writing—review and editing.

Disclosure Statement

Under a license agreement between Corrie Health and Johns Hopkins University, the university owns equity in Corrie Health. The university and S.S.M. are entitled to royalty distributions related to Corrie Health. In addition, S.S.M. is a cofounder of and holds equity in Corrie Health. This arrangement has been reviewed and approved by Johns Hopkins University in accordance with its conflict of interest policies. S.S.M. has also received research and material support from Apple and iHealth. Furthermore, S.S.M. is on the Advisory Board for Care Access and reports personal consulting fees from Amgen, AstraZeneca, BMS, Chroma, Kaneka, Merck, NewAmsterdam, Novartis, Novo Nordisk, Premier, Sanofi, and 89bio. E.M.S. reports personal consulting fees from Corrie Health. All other authors declare no conflicts of interest.

Funding Information

No direct funding for this study. Outside of this work, S.S.M. reports support from the American Heart Association (20SFRN35380046, 20SFRN35490003, #878924, #882415, #946222), the Patient-Centered Outcomes Research Institute (ME-2019C1-15 328, IHS-2021C3-24147), the National Institutes of Health (P01 HL108800 and R01AG071032), the David and June Trone Family Foundation, the Pollin Digital Innovation Fund, Sandra and Larry Small, CASCADE FH, Google, Amgen, and Merck. E.M.S. reports support from the American Heart Association (20SFRN35380046 and #878924) and National Institutes of Health (U01HL096812).