Telehealth Surge Driven by Behavioral Health, Chronic Illness Visits, Research Finds

While it’s been well-documented that the COVID-19 pandemic has led to an increase in the use of and demand for telehealth services, a new study now explores the specific patient care issues that have driven this surge in virtual care visits.

The researchers, who are affiliated with RAND Corporation, Harvard Medical School, and telehealth company Doctor on Demand—and who were published recently in the Journal of Medical Internet Research—reported data as a percentage change from the baseline week during two distinct time periods: February through June 2019 and then the same time period in 2020, based on four categories of visits: respiratory illness, unscheduled behavioral health, scheduled behavioral health (including therapy and psychiatry), and chronic illness.

Importantly, the researchers stated that when COVID-19 outbreaks emerged, many patient care organizations were already conducting telehealth visits in high volumes. Prior to 2020, large telehealth service providers were providing millions of telehealth visits per year, offering patients immediate access to clinicians via videoconferencing visits from personal electronic devices, they pointed out.

To date, however, research on telehealth implementation during the COVID-19 pandemic has focused on the experiences of professionals new to telehealth, they added. But little is known about the impact of COVID-19 among telehealth services that were functional prior to the pandemic, the researchers contend. “To address this gap in the literature, we collaborated with a prominent telehealth service provider, Doctor On Demand, Inc., to describe their experience during the ongoing pandemic and to explore how the number of telehealth visits, reasons for visits, and patients served have changed over time.”

Indeed, in 2020, after examining telehealth data from Doctor On Demand before and during the pandemic, the researchers found that the total visit volume for telehealth services increased considerably from March through April 7, 2020 (59 percent above the baseline) and then declined through the week of June 2 (15 percent above the baseline).

The study revealed that visits for respiratory illnesses increased through the week of March 24, 2020, with visit volume up 30 percent above the baseline, and then steadily declined through the week of June 2 to 65 percent below the baseline.

Meanwhile, higher relative increases were observed for unscheduled behavioral health and chronic illness visits through April (109 percent and 131 percent above the baseline, respectively), before a decline through the week of June 2 (69 percent and 37 percent above the baseline, respectively).

What’s more, in 2020, differences in visit trends by patient location were observed. All visits among urban residents peaked at 58 percent above baseline, whereas visits among rural residents peaked at 64 percent above baseline.

Further, individuals residing in low-income regions accounted for 47 percent of all visits in January and February 2020, and 50 percent of all visits in April 2020. The proportion of patients new to the Doctor on Demand telehealth platform increased from 40 percent in February 2020 to 53 percent in April 2020. For this data point, the researchers noted that while “there has been substantial discussion about the ‘digital divide’ in healthcare and concerns that patients from lower-income communities may not have the necessary technology or digital literacy to participate in video-based visits, it is reassuring that the proportion of telehealth visits by patients from lower-income communities was stable during the early weeks of the COVID-19 pandemic.”

They also noted that specific to behavioral health, it’s still unclear whether the increased demand for these visit types during the study period was driven by a higher incidence of mental health concerns due to pandemic-related stressors, or was attributed to the reduced capacity of healthcare providers practicing in the community.

The researchers further concluded, “Although this telehealth service provider [Doctor on Demand] observed a substantial increase in the volume of visits during the COVID-19 pandemic, it is interesting to note that this growth was not fueled by COVID-19 concerns, but by visits for behavioral health and chronic illness. Telehealth services may play a role as a ‘safety valve’ for patients who have difficulty accessing care during a public health emergency.”