Who is Using Telehealth in Primary Care? Safety Net Clinics and Health Maintenance Organizations (HMOs)

• Accountable Care Organizations
• Health Maintenance Organizations
• Patient-Centered Care
• Family Physicians
• Safety-net Providers
• Surveys and Questionnaires
• Telemedicine
• Work

Technological advances provide an avenue to improve patient access to care,¹ increase the continuity of care,² and improve health outcomes³ through telehealth services. A 2014 survey conducted by the American Academy of Family Physicians and analyzed by the Robert Graham Center found that only 15% of the responding family physicians (557 survey responses; 31% of the sample) had used telehealth services in the preceding year.⁴ Telehealth services were defined in the survey to mean either direct provision of primary care services, primary care and subspecialist referral services, e-visits, and store and forward services. Little is known about how telehealth usage varies by practice setting.

The 2014 American Academy of Family Physicians Telehealth Survey also asked respondents to indicate (through checkboxes) their primary practice location's affiliations or designations for federal designation (federally qualified health center or community health center, rural health clinic, or Indian health service); academic health center; HMO; accountable care organization; and/or certified PCMH. Respondents were able to select all affiliations or designations that applied to their primary practice setting. Telehealth users were statistically more likely than non–telehealth users to be affiliated with a federally designated safety net clinic (28% vs 15%; P < .000) or an HMO (19% vs 11%; P = .01) (Table 1).

While previous reports highlighted the limited adoption of telehealth in primary care, these findings suggest greater use among family physicians in safety net and managed care settings. The source of this variation requires further investigation if policymakers wish to understand how family physicians in all settings can use technological advancements to better care for their patients. The lack of significant differences between users and nonusers in a PCMH may suggest a need for greater evidence of telehealth's benefits and incentives for its adoption on the road to practice transformation.

• Received for publication December 7, 2015.
• Revision received March 31, 2016.
• Accepted for publication April 18, 2016.