Audio-only telehealth visits still make up a significant portion of primary and behavioral healthcare at federally qualified health centers in California, according to a RAND Corporation study published in JAMA.

Though audio-only visits have declined from the height of the COVID-19 pandemic, researchers found they accounted for one in five primary care visits and two in five behavioral health visits among people who received care at FQHCs in the state in August 2022.

The study analyzed data from 30 multisite FQHCs in California that served 1.3 million low-income patients. It found total adjusted primary care visits actually increased by 8.5% from February 2020 to August 2022. Behavioral health visits increased 23.3%.

The study's authors argue those increases were likely due to the ability to widely offer telehealth services even as the clinics had fewer staffers. 

"It is likely that these safety net clinics continued to deliver audio-only visits in high volume because of their role in improving access to health services," Lori Uscher-Pines, lead author of the study and a senior policy researcher at RAND, said in a statement. "Our study raises important questions about what kind of role we want audio-only visits playing in the care of disadvantaged populations and the public in general going forward."

The proportion of in-person primary care visits increased from 29.7% to 71.4% from April 2020 to August 2022, while audio-only decreased from 66.5% to 21.4%. Video visits increased from 3.8% to 7.2%. 

For behavioral health, in-person visits increased from 19.6% to 37.4%. Audio-only visits decreased from 74.2% to 39.3%, while video visits increased from 7.7% to 23.2%.

Audio-only visits reached their peak in April 2020 for primary care and March 2021 for behavioral healthcare. 

WHY IT MATTERS

Though clinics have been increasing their video visits, the study's authors note they still relied on audio-only calls, likely because of technical barriers for providers and patients. California's Medicaid program also reimbursed for audio-only telehealth, so providers didn't have a financial incentive to cut down on audio calls. 

Still, the study's authors note the high level of use among low-income patients could be a concern as the quality of audio-only telehealth hasn't been established.

"It appears likely that audio-only visits in these settings will remain widespread in coming years," Uscher-Price said. "More research is needed on the effectiveness of audio-only visits to inform their use in safety net settings."

Howard Rubin will offer more detail during the HIMSS23 session "Increasing Access to Care for Rural and Underserved Communities." It is scheduled for Tuesday, April 18 at 3 p.m. – 4 p.m. CT at the South Building, Level 1, room S105A.