Michael Barnett and others published a short research letter at JAMA yesterday.** They looked into how telehealth is being used.
Use of telemental health increased significantly faster in counties with no psychiatrists (P < .001 for interaction) (Figure) and in states with comprehensive parity mandates (P = .02 for interaction). In contrast, growth of primary care telemedicine was not associated with primary care physician supply (P = .76 for interaction)
The big findings from this paragraph are:
- Telehealth is used a lot for mental health visits when there are no local mental health providers
- Telehealth is used a lot when the state supports adoption
- Telehealth is not used more for primary care in counties with low PCP supply
The first two results seem intuitive to me.
The last result is surprising. I would have expected telemedicine to be used as a PCP substitute and complement in counties where there are few PCPs. I would have expected that areas with few PCPs would have seen the most telemedicine for PCP services.
Telemedicine often described as big specialty care in rural populations, but we saw a different pattern:
– 83% of telemedicine users in lived in urban areas
– 53% of telemedicine was for primary care (eg colds) and 39% was for mental health
– Only 8% for everything else!— Michael L. Barnett (@ml_barnett) November 27, 2018
Primary care telemedicine is being used for urban convenience. And that can be valuable as hell when there is a known minor problem where the desired outcome is either a professional saying that something is “OK”, “OK once you get a cheap prescription” or screens out bad, low probability outcomes. If I could have taken my kids to telemedicine visit in order to get a doctor’s note saying that they could return to daycare after they were sent home with a runny nose, I would have done that in a second even if the co-pay was the same or higher than an in-person visit.
Right now, telemedicine for primary care is not filling in for care deserts in low provider density regions. It is doing that for pysch services.
I wonder how we should think about telemedicine for primary care? Is using the framework by Rand’s Martsolf used for urgent care clinics where they are not reducing costs from ER visits on net but serve as a service for the worried well appropriate? I am very curious about the differences in marketing, presentation and patient experience for the psych utilization compared to the PCP utilization as the psych services seem to be working as a substitute for humans in rural areas.
Telemedicine is a place where we’re going to spend a lot of time and money on over the next decade so figuring out how it is working is critical.
** Barnett ML, Ray KN, Souza J, Mehrotra A. Trends in Telemedicine Use in a Large Commercially Insured Population, 2005-2017. JAMA. 2018;320(20):2147–2149. doi:10.1001/jama.2018.12354
Telemedicine is not a rural savior (yet?)Post + Comments (18)