Family Physicians Report Considerable Interest in, but Limited Use of, Telehealth Services

Miranda A. Moore; Megan Coffman; Anuradha Jetty; Kathleen Klink; Stephen Petterson; Andrew Bazemore

doi:10.3122/jabfm.2017.03.160201

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Figure 1.
Definition of telehealth.

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Table 1.

Comparison of Demographic Characteristics and Barriers to Telehealth Use in 2014 for Family Physicians Responding to the January 2015 Robert Graham Center Survey,^* by Telehealth Use

Characteristic	Nonrespondents (n = 3443)	All Respondents (n = 1557)	Telehealth Users (n = 225)	Nonusers (n = 1332)	P Value^{^†}
Sex					.720
Female	1477 (42.9)	588 (41.0)	90 (42.3)	498 (40.8)
Male	1966 (57.1)	969 (59.0)	135 (57.7)	834 (59.2)
Type of medical degree					.120
Allopathic	3109 (90.3)	1410 (83.9)	210 (88.7)	1200 (83.3)
Osteopathic	334 (9.7)	147 (16.1)	15 (11.3)	132 (16.7)
Location of medical school
United States	2748 (79.8)	1371 (79.7)	202 (81.7)	1169 (79.4)	.556
International	695 (20.2)	186 (20.3)	23 (18.3)	163 (20.6)
Practice location
Urban	2834 (82.3)	1047 (83)	112 (73.9)	935 (87.8)	<.001
Rural	609 (17.7)	510 (17)	113 (26.1)	397 (15.1)
Years in practice
0–10		361 (28.1)	62 (34.6)	299 (27.2)	.060
11–20		513 (33.9)	64 (27.9)	449 (34.7)	.070
21–30		411 (23.7)	64 (25.9)	347 (23.4)	.450
≥31		256 (14.3)	33 (11.7)	223 (14.7)	.230
Missing data		16 (1.0)	2 (0.5)	14 (1.1)
Electronic health record use					.006
Currently a user		1440 (93.0)	218 (97.3)	1222 (91.9)
Not current a user		107 (6.5)	5 (2.2)	102 (7.6)
Missing data		10 (0.5)	2 (0.5)	8 (0.5)
Type of care provided
General primary care		1330 (84.4)	175 (76.4)	1155 (85.5)	.004
Hospital/urgent/emergency care or other		227 (14.3)	46 (21.7)	161 (13.3)
Missing data		20 (1.3)	4 (1.9)	16 (1.2)
Family physicians at the practice site
1–5		1067 (68.6)	138 (59.1)	929 (70.0)	.005
≥6		471 (30.2)	85 (39.5)	386 (28.8)
Missing data		19 (1.2)	2 (0.9)	17 (1.2)
Practice ownership					<.001
Private		572 (36.6)	52 (21.9)	520 (38.6)
Owned by a hospital or health system		662 (41.1)	95 (37.6)	567 (41.6)
Integrated health system		75 (5.6)	19 (11.3)	56 (4.8)
Other		227 (15.4)	58 (29.0)	169 (13.5)
Missing data		21 (1.3)	1 (0.2)	20 (1.5)
Barriers to using telehealth
Any barrier from the list		1382 (88.8)	118 (83.6)	1194 (89.6)	.008
Cost of equipment		704 (45.4)	78 (33.6)	626 (47.0)	.001
Lack of training on how to use telehealth		828 (53.7)	91 (40.7)	737 (55.5)	<.001
Reimbursement by insurers		829 (53.3)	102 (43.2)	727 (54.7)	.004
Liability issues associated with telehealth		595 (41.1)	56 (26.6)	539 (43.2)	<.001
Other		325 (19.9)	56 (22.2)	269 (19.6)	.400

Data are n (%). Weighted percentages may not add up to 100 because of rounding and non–mutually exclusive categories.
↵* Respondents were from among a random sample of 5000 family physicians in direct patient care from the 2014 American Medical Association Physician Masterfile, with oversampling of rural family physicians at a rate of 2 to 1.
↵† P values were calculated using the χ² test of significance between telehealth users and nonusers.

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Table 2.

Factors Associated With Telehealth Use in 2014 for Family Physicians Responding to the January 2015 Robert Graham Center Survey^*

Variable	Odds Ratio	Confidence Interval
Sex
Female	1.07	0.75–1.54
Male	Reference
Type of medical degree
Allopathic	Reference
Osteopathic	0.57	0.31–1.02
Location of medical school
United States	Reference
International	0.8	0.48–1.32
Practice location
Urban	Reference
Rural	3.05	2.19–4.25
Years in practice
1–10	Reference
11–20	0.66	0.43–1.01
21–30	0.87	0.55–1.37
>31	0.62	0.36–1.08
Electronic health record use
Currently a user	3.42	1.22–9.65
Not currently a user	Reference
Type of care provided
Hospital/urgent/emergency care or other care	Reference
General primary care	0.51	0.33–0.80
Family physicians at the practice site
1–5	Reference
≥6	1.32	0.93–1.89
Practice ownership
Private	Reference
Hospital health system	1.26	0.81–1.95
Integrated health system	3.53	1.79–6.98
Other	3.56	2.17–5.85
Constant	0.047	0.02–0.15

↵* Respondents were from among a random sample of 5000 family physicians in direct patient care from the 2014 American Medical Association Physician Masterfile, with oversampling of rural family physicians at a rate of 2 to 1. There are 1508 observations.

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Table 3.

Factors Associated With Indicating That the Item Is a Barrier to Using Telehealth in 2014 for Family Physicians Responding to the January 2015 Robert Graham Center Survey^*

Variable	Any		Cost		Training		Reimbursement		Liability Issues
Variable	Odds Ratio	Confidence Interval	Odds Ratio	Confidence Interval	Odds Ratio	Confidence Interval	Odds Ratio	Confidence Interval	Odds Ratio	Confidence Interval
Telehealth user	0.51	0.33–0.77	0.63	0.46–0.86	0.54	0.40–0.73	0.82	0.61–1.11	0.56	0.40–0.78
Sex
Female	1.10	0.76–1.58	0.99	0.79–1.24	1.52	1.21–1.91	0.97	0.78–1.22	1.11	0.88–1.40
Male	Reference		Reference		Reference		Reference		Reference
Type of medical degree
Allopathic	Reference		Reference		Reference		Reference		Reference
Osteopathic	0.93	0.51–1.69	1.18	0.82–1.68	1.02	0.71–1.47	0.79	0.55–1.13	1.04	0.72–1.50
Location of medical school
United States	Reference		Reference		Reference		Reference		Reference
International	0.68	0.41–1.13	0.82	0.58–1.15	0.75	0.54–1.06	0.93	0.66–1.30	1.57	1.12–2.19
Practice location
Urban	Reference		Reference		Reference		Reference		Reference
Rural	1.14	0.78–1.65	1.11	0.88–1.39	0.95	0.76–1.20	0.84	0.67–1.06	0.67	0.53–0.85
Years in practice
1–10	Reference		Reference		Reference		Reference		Reference
11–20	0.86	0.53–1.38	0.86	0.65–1.14	0.69	0.51–0.92	1.02	0.77–1.36	0.77	0.57–1.02
21–30	0.78	0.47–1.28	0.71	0.52–0.97	0.66	0.48–0.90	0.96	0.71–1.31	0.76	0.56–1.04
>31	0.68	0.38–1.22	0.71	0.49–1.01	0.62	0.43–0.89	0.81	0.56–1.16	0.74	0.52–1.08
Electronic health record use
Currently a user	1.27	0.67–2.40	0.82	0.54–1.25	1.14	0.75–1.73	1.17	0.77–1.78	0.86	0.56–1.31
Not currently a user	Reference		Reference		Reference		Reference		Reference
Type of care provided
Hospital/urgent/ emergency care or other care	Reference		Reference		Reference		Reference		Reference
General primary care	1.41	0.91–2.19	1.53	1.12–2.09	1.61	1.18–2.18	1.68	1.24–2.27	0.96	0.70–1.32
Family physicians at the practice site
1–5	Reference		Reference		Reference		Reference		Reference
≥6	0.96	0.66–1.39	0.83	0.66–1.05	1.05	0.83–1.32	0.96	0.77–1.21	0.8	0.63–1.02
Practice ownership
Private	Reference		Reference		Reference		Reference		Reference
Hospital health system	0.91	0.61–1.35	0.78	0.62–1.00	0.89	0.70–1.14	0.84	0.66–1.07	0.90	0.70–1.14
Integrated health system	0.7	0.33–1.45	0.49	0.29–0.84	1.08	0.65–1.81	0.55	0.33–0.92	0.74	0.43–1.25
Other	0.91	0.55–1.53	0.91	0.66–1.25	0.84	0.60–1.16	0.51	0.37–0.71	0.67	0.48–0.95
Constant	7.54	3.18–17.88	1.11	0.63–1.94	0.99	0.56–1.74	0.96	0.55–1.68	1.24	0.70–2.18

↵* Respondents were from among a random sample of 5000 family physicians in direct patient care from the 2014 American Medical Association Physician Masterfile, with oversampling of rural family physicians at a rate of 2 to 1. There are 1508 observations.

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Table 4.

Characteristics of Telehealth Users in 2014 (n = 225) among Family Physicians Responding to the January 2015 Robert Graham Center Survey^*

Characteristics of Telehealth Use
Frequency (times per year)
1–2	49	(22.5)
3–5	59	(25.7)
6–10	27	(9.3)
11–15	14	(6.0)
16–20	6	(2.2)
>20	36	(20.0)
Missing data	34	(14.2)
Method
Real-time video	112	(48.7)
Shared computer screen images with audio	20	(10.8)
Stored or forwarded image or text transmission	60	(30.7)
Other	26	(9.6)
Missing data	39	(16.7)
Clinical purpose
Diagnosis or treatment	122	(55.2)
Second opinion	45	(19.9)
Follow-up	49	(20.9)
Chronic disease management	54	(25.7)
Emergency care	42	(16.1)
Administrative purpose	11	(5.7)
Other	30	(13.0)
Missing data	28	(12.3)
Types of physicians or clinicians referred
Specialists	149	(68.1)
Other family physicians	12	(6.0)
General internal medicine physicians	10	(5.7)
Pediatricians	7	(3.3)
Mental health treatment providers	70	(28.0)
Physical therapists	12	(6.4)
Dieticians	16	(8.9)
Other	24	(9.3)
Missing data	39	(17.3)

Data are n (%). Weighted percentages may not add up to 100 because of rounding and non–mutually exclusive categories.
↵* Respondents were from among a random sample of 5000 family physicians in direct patient care from the 2014 American Medical Association Physician Masterfile, with oversampling of rural family physicians at a rate of 2 to 1.