Robert Graham Center:Summary of Telehealth

Projects

Megan Coffman, MS

October 28, 2016

Robert Graham Center The Robert Graham Center aims to improve individual and population healthcare delivery

through the generation or synthesis of evidence that brings a family medicine and primary care perspective to health policy

deliberations from the local to international levels.

Robert Graham Center – Who We Are

Research Topics

Mapping Tools

What is Telehealth?• Telehealth: the exchange of medical

information from one location to another via electronic communications

Why Telehealth? • Telehealth is shown to:

– expand patients access to care, – increase continuity of care, – improve coordination of care – reduce healthcare costs, and – improve health outcomes

• Some indication of low usage in primary care

Family Physicians and Telehealth

Funded by Anthem,Inc.

Highlights from the Literature Review and Expert Panel

• There is very little research on telehealth in primary care

• The literature indicates that patients appreciate the convenience of access to telehealth services, and are satisfied with the care they receive remotely

• Patients see saving time and travel as benefits of telehealth compared to in-person care

Survey Objectives• Measure penetration of telehealth into primary care

setting– Hypothesis: low penetration

• Characterize Family Physicians (FPs) who use telehealth– Hypothesis: higher use in rural setting, larger practices,

and younger physicians• Investigate Attitudes/Beliefs of FPs regarding

telehealth– Hypothesis: Users have more favorable attitudes/beliefs

Who did we ask? • Survey of 5,000 randomly selected FPs

– AMA Physician Masterfile (2014) linked to AAFP member list

– FPs in direct patient care– Oversample rural 2:1

The Survey

Telehealth DefinedTelehealth services defined as:

1. Primary care services: a physician providing care for a patient via live interactive video and/or

2. Primary care and specialist referral services: a primary care provider consulting with a specialist via live interactive video and/or

3. Store and Forward: sharing electronic patient data between a primary care provider and specialist across locations

Survey Data• 1,557 survey responses were analyzed

– 1,630 surveys were returned (31% response rate)– 53 surveys were returned but not used

• Non-unique ID• Respondent indicated they did NOT engage in direct

patient care or did not answer this question

• Sample weights were used to ensure the estimates computed were representative of family physicians across the United States

Results: Demographics• 15% had used telehealth services in the

last 12 months (85% had NOT) (N=225)• Telehealth users were more likely to

– rural setting (26% versus 12%, p<0.01)– use an EHR (97% vs. 92%, p<0.01)– work with six+ FPs (40% vs. 29%, p<0.01)

Prevalence of Telehealth Use by Type of Service Used

Source: Robert Graham Center Analysis of 2014 AAFP Telehealth Survey of Family Physicians, N=225

Results: Attitudes and Beliefs

• Telehealth users and non-users agree:– Telehealth improves access to care for my

patients. (89% users vs. 77% non-users, p<0.01)

– Telehealth improves the continuity of care for my patients. (75% vs. 68%, p<0.01)

– Patients prefer to see their doctor in person. (83% vs. 94%, p<0.01)

Results: Barriers to Using Telehealth

Benefits and Barriers to Telehealth Use

FP Survey Study Conclusion

• FPs views of telehealth are generally positive

• Barriers to larger adoption remain• Small but significant number of family

physicians who are providing telehealth services for patients

CERA Survey of Family Medicine Directors

19%

11%

71%

Telehealth Capacity of Residency Programs Surveyed

Video and Evisits or Store Forward VideoOnly Evisits or Store Forward Only

Percent of Residency Programs Who Indicated Each Reason by Mode of Telehealth Service Delivery

Diagnosis & Treatment

Second Opinion Follow-up Chronic Disease Management

Emergency Care Administration0

10

20

30

40

50

60

48.6

11.4

22.928.6

2017.1

48.1

21.7

55.7

49.1

16

36.8

Live Interactive VideoEvisits / Store Forward

Consumer Telehealth Project

Consumer Expert Panel

Consumer Survey

Thank You and More • To learn more about the Robert Graham

Center’s work, visit our website: http://www.graham-center.org/rgc/home.html

• If you have specific questions on the telehealth project, email me at:

mcoffman@aafp.org