ArticlePDF Available


Objectives: The increasing and widespread availability of personal technology offers patients and clinicians the opportunity to utilize real-time virtual communication to enhance access to health services. Understanding the perceived value of different modes of care may help to shape the future use of technology. Study design: Cross-sectional surveys of patients and clinicians participating in telehealth virtual video visits (VVVs) in an academic health system. Methods: We administered surveys to 426 unique established patients and 74 attending physicians in our hospital to measure perceptions of the comparative experience of VVVs and office visits; 254 patients and 61 physicians completed the surveys. Results: When comparing VVVs and office visits, 62.6% of patients and 59.0% of clinicians reported no difference in "the overall quality of the visit." VVVs were vastly preferred to office visits by patients for convenience and travel time. A majority (52.5%) of clinicians reported higher efficiency of a VVV appointment. Conclusions: For established patients, VVVs may provide effective follow-up and enhanced convenience when compared with traditional office visits.
40 JANUARY 2019
elemedicine visits have been used in the United States to
enhance access to healthcare, most notably for people who
live in remote and underserved areas.1,2 The increasing avail-
ability of personal technology (89% have internet access, 77% are
online daily3) oers patients and clinicians the opportunity to utilize
real-time virtual communication to enhance access for patients
when transportation challenges, schedules, or physical disability
make oce visits dicult in any geography.4 Although face-to-face
interactions may be preferred in some circumstances by patients or
clinicians, the convenience of accessing healthcare consultations
from the home or oce may save lost time at home or work, travel
time, and missed and rescheduled appointments.
Understanding the
perceived relative value of dierent modes of healthcare services may
help to shape the use of virtual or remote healthcare technologies.
Eective population health management is a balancing act that
requires consideration of patient needs and preferences for more
exible and timely access to consultation, accountability to payers
by managing high costs, and understanding how to leverage new
technologies.12,13 System learning that demonstrates the value of
dierent types of “visits” for the system and the patient is essential.
We initiated the Massachusetts General Hospital (MGH) TeleHealth
program in 2012, oering a range of telemedicine services in 15 clinical
departments. This paper describes experiences with virtual video
visits (VVVs): 2-way audiovisual synchronous videoconferencing
between the MGH clinician and patient. The research reported
here focuses on the patient and clinician experience of a VVV in
a full year of operation to understand its value and comparative
experience with VVVs and oce visits.
Study Setting and Telemedicine
Clinicians in 5 specialties (psychiatry, neurology, cardiology,
oncology, and primary care) were trained in how to provide a
VVV throughout the rst year and on a rolling basis. Oncology
and primary care VVVs were not implemented until late in the
data collection period. Clinicians oered VVVs as an option to
Patient and Clinician Experiences With
Telehealth for Patient Follow-up Care
Karen Donelan, ScD, EdM; Esteban A. Barreto, MA; Sarah Sossong, MPH; Carie Michael, SM; Juan J. Estrada, MSc, MBA;
Adam B. Cohen, MD; Janet Wozniak, MD; and Lee H. Schwamm, MD
OBJECTIVES: The increasing and widespread availability
of personal technology offers patients and clinicians the
opportunity to utilize real-time virtual communication
to enhance access to health services. Understanding the
perceived value of different modes of care may help to shape
the future use of technology.
STUDY DESIGN: Cross-sectional surveys of patients and
clinicians participating in telehealth virtual video visits
(VVVs) in an academic health system.
METHODS: We administered surveys to 426 unique
established patients and 74 attending physicians in our
hospital to measure perceptions of the comparative
experience of VVVs and office visits; 254 patients and
61physicians completed the surveys.
RESULTS: When comparing VVVs and office visits, 62.6%
of patients and 59.0% of clinicians reported no difference
in“the overall quality of the visit.” VVVs were vastly
preferred to office visits by patients for convenience and
travel time. A majority (52.5%) of clinicians reported higher
efficiency of a VVV appointment.
CONCLUSIONS: For established patients, VVVs may
provide effective follow-up and enhanced convenience when
compared with traditional office visits.
Am J Manag Care. 2019;25(1):40-44
VOL. 25, NO. 1 41
Virtual vs In-Person Office Visits
established patients based on their professional
assessment of the suitability of the mode of
visit for the individual patient’s situation (eg,
patient could communicate eectively in this
mode, physical examination was not critical
at the visit). Clinicians were compensated by
MGH for conducting these VVVs because they
were not covered by payers in Massachusetts.
In advance of the VVV, participating patients
received education, instruction, and phone-
based technology support and testing for
installation of the visit software. Patients were
not charged insurance co-payments for the visit.
Survey Methods
The data reported here come from surveys of patients and clinicians
in the MGH TeleHealth program. This study was reviewed and
approved by the Partners Health Care Oce of Human Research.
The surveys we employed were developed by the MGH Center for
TeleHealth leadership and Mongan Institute Health Policy Center
research team, including experts in survey and health services
research, telemedicine, clinical medicine, and health management.
We included selected patient experience measures developed by
the Consumer Assessment of Healthcare Providers and Systems
(CAHPS)15 andaugmented with items developed for this mode of
visit. Surveys were pretested with patients and rened. Key domains
included technology and communication quality, visit quality and
experience, patient time and costs, and willingness to pay for a VVV.
Of 426 eligible patients, 254 (60%) completed surveys using a
secure web tool. Eligible patients had at least 1 VVV during the
accrual period and at least 1 oce visit in the 6-month period
prior. Initial recruitment was by email request within 1 week of
the VVV. Patients whose email addresses were not functional were
contacted by postal mail or telephone. Persistent nonresponders to
the survey were oered a $10 incentive after 4 weeks of attempts
without reaching the patient. Patients younger than 18 years were
not directly contacted; rather, surveys were sent to their parents.
Of 74 eligible clinicians (physicians, nurse practitioners, psycholo-
gists) who provided at least 1 VVV to program patients during the
study period, 61 (82%) completed surveys online, with recruitment
by email. An gift certicate valued at $50 was oered
to each physician as an honorarium for participation.
The results reported here are descriptive; subgroup comparisons
within patient and clinician populations use χ
or t test comparisons
as indicated, and analyses comparing patient and clinician responses
utilize 2-sample t tests of the dierence in proportions. All analyses
were conducted using SPSS version 23 (IBM Corp; Armonk, New York).
Patient characteristics are shown in the eAppendix Table (eAppendix
available at VVV patients were diverse in age and gender
and were predominantly white and non-Hispanic, consistent with
patient demographics in our system. Patients receiving behavioral
health care are overrepresented due to the rapid uptake of VVV
by those clinicians and patients. No signicant dierences were
measured in characteristics of respondents and nonrespondents.
Clinician respondents were psychologists and psychiatrists
(34%), neurologists (38%), cardiologists (10%), oncologists (2%),
andprimary care clinicians (16%).
Patient Experience of VVVs
Patient experience with a VVV was measured in multiple items.
Responses are shown in the Table by specialty, comparing neurology
and cardiology patient responses with those of the psychiatry patients
(referent). We used 4 measures from the CAHPS Clinician Group visit
to assess patient experience with eciency and communication
during VVVs. Overall, 80% or more respondents answered “yes,
denitely” to these items; 82.3% responded “yes, denitely” to
whether they would recommend VVV to their family and friends.
On a scale of 0 to 10, where 0 is the worst possible visit and 10 is
the best visit, 68.5% rated the visit a 9 or 10.
We asked patients to consider whether the care provided during
their recent VVV could have been provided in another way and
still met their needs, asking “Do you think the health issues you
discussed with clinicians today could just as easily have been
addressed by [insert visit mode]?” Nearly 90% of patients agreed
that theirissues could also have been addressed in an oce visit
(denitely, 70.8%; somewhat, 17.8%) and nearly 60% by telephone
calls (denitely, 23.2%; somewhat, 36.7%). The results for secure
email (denitely, 7.2%; somewhat, 23.5%) and text messaging
(denitely, 3.6%; somewhat, 12.7%) suggest that they are less often
appropriate substitutes (data not shown).
Patient and Clinician Comparisons of Office Visits
and VVVs
The Figure shows patient and clinician responses to a series of
comparative questions about oce visits and VVVs that were asked
of both groups. Expanded data are shown in eAppendix Figures 1
and 2—one with patient data, one with clinician data—and include
Telemedicine visits have been used to provide healthcare access to more remote populations.
In a busy health system, telehealth visits were incorporated for established patients to allow
patient–clinician interaction in a new, more convenient mode. In the first full year of patient
visits in this new mode, we found that:
Patients rated these visits highly and the majority would recommend them to family and friends.
Using standard measures of patient experience, most patients and clinicians perceived no
loss of communication in virtual video visits compared with office visits, although clinicians
were somewhat more likely to see loss of personal connection as a problem.
Patients perceived considerable added convenience, saved travel time, and expressed
willingness to pay co-payments for this visit option.
Virtual visits are an important and useful option in clinical care.
42 JANUARY 2019
several items that were directed only to one
group or the other.
Most patients (62.6%) and clinicians (59.0%)
reported “no dierence” between virtual and
oce visits on “the overall quality of the visit.
When rating “the personal connection felt
during the visit,” 32.7% of patients and 45.9%
of clinicians reported that the “oce visit is
better,” but more than half of the respondents
(patients, 59.1%; clinicians, 50.8%) said that
there was “no dierence.
Patient Willingness to Pay for VVV
eAppendix Figure 3 shows data on patient
willingness to pay for VVV out of pocket. Patients
were not initially charged co-payments. However,
the majority of patients expressed a willingness
to pay a co-payment of up to $50. Among those
willing to bear the full cost of the VVV, more than
one-third had no current co-payment and all
had private (vs public) insurance. We conducted
bivariate analyses of the willingness to make
co-payments for VVV by both self-reported
travel time and cost of attending oce visits.
Among those who traveled more than 90 minutes
to an oce visit, 51.5% indicated they would
pay a co-payment of more than $50 for a VVV
compared with 30.4% of those who traveled less
than 30 minutes. Among patients who spent
$25 or more on travel to attend an oce visit,
73.2% would pay a co-payment of $26 to $50
for a VVV and 97.6% would pay a co-payment
of $10 to $25 (travel data not shown).
Increased interest in new strategies for managing
population health and episodic specialty care,
coupled with the widespread availability of
communications technologies, have encour-
aged the exploration of the appropriate roles
of dierent modes of clinical encounters or
Our data—gathered from patients and
clinicians during and following an initial full
year of experience with the MGH Center for
TeleHealth’s VVV implementation—show a high
degree of patient and clinician satisfaction, as
measured by both ratings of overall visit quality
and willingness to recommend the visits.
VVVs are perceived by the majority of patients
as the same as or better than oce visits in
convenience and cost, at the same level of
TABLE. Patient Experience With Virtual Video Visits
(N = 254)
(n = 113)
(n = 92)
(n = 30)
Thinking about your most recent virtual
video visit, please tell us how much you
agree with the following items:
I saw my clinician within 15 minutes of
my appointment time. Reference P = .609 P = .284
Yes, definitely agree 88.2% 90.3% 88.0% 83.3%
Yes, somewhat agree 6.3% 6.2% 4.3% 10.0%
No 3.5% 1.8% 4.3% 6.7%
Not answered 2.0% 1.8% 3.3% 0.0%
My clinician explained things in a way
that was easy to understand. Reference P = .046 P = .791
Yes, definitely agree 92.9% 95.6% 88.0% 96.7%
Yes, somewhat agree 3.9% 1.8% 7.6% 3.3%
No 0.8% 0.0% 1.1% 0.0%
Not answered 2.0% 2.7% 3.3% 0.0%
My clinician listened carefully to me. Reference P = .026 P = .791
Yes, definitely agree 92.5% 95.6% 87.0% 96.7%
Yes, somewhat agree 4.7% 1.8% 9.8% 3.3%
No 0.8% 0.0% 1.1% 0.0%
Not answered 2.0% 2.7% 2.2% 0.0%
My clinician spent enough time with me. Reference P = .002 P = .656
Yes, definitely agree 98.8% 94.7% 80.4% 96.7%
Yes, somewhat agree 7.1% 2.7% 15.2% 3.3%
No 1.2% 0.9% 1.1% 0.0%
Not answered 2.0% 1.8% 3.3% 0.0%
On a scale from 0 to 10, where 10 is your
BEST visit and 0 is your WORST possible visit,
how would you rate your virtual video visit?
Reference P = .771 P = .168
9-10 68.5% 66.3% 67.4% 80.0%
7-8 25.2% 27.5% 23.9% 20.0%
6 5.1% 5.3% 6.5% 0.0%
Would you recommend this clinician
toyour family and friends? Reference P = .034 P = .544
Yes, definitely agree 89.0% 93.8% 84.8% 96.7%
Yes, somewhat agree 7.5% 5.3% 8.7% 3.3%
No 1.6% 0.0% 2.2% 0.0%
Not answered 2.0% 0.9% 4.3% 0.0%
Would you recommend a virtual visit to
your family and friends? Reference P = .416 P = .076
Yes, definitely agree 82.3% 86.7% 82.6% 66.7%
Yes, somewhat agree 13.4% 11.5% 10.9% 33.3%
No 0.8% 0.0% 2.2% 0.0%
Not answered 3.5% 1.8% 4.3% 0.0%
Source: Data from the TeleHealth Patient Survey, February 2014-March 2015.
VOL. 25, NO. 1 43
Virtual vs In-Person Office Visits
quality and personal connection. Patients appear to value the
face-to-face interactive nature of VVVs; they perceive oce or
telephone encounters as the main alternatives to this new type
of visit, rather than email or structured questionnaires, likely
because they maintain a real-time personal connection. Even
though VVVs represent a great convenience, our data reinforce that
they are unlikely to be a useful substitute for an in-oce visit in
some clinical situations—for example, those with more complexity
and need for physical examination or observation. More research
is needed to study the association of the care delivery modality
(in-person vs telehealth) with total cost and clinical outcomes and to
understand settings in which telehealth aects healthcare value.
Theregulatory, administrative, and legal environment related to
the conduct of telehealth visits is in constant ux; delivery of care
to established patients across state lines adds further complexity.
The Chronic Care Act of 2017, enacted in 2018, takes some small
steps toward relaxing reimbursement and regulatory restrictions
in selected diseases and insurance markets; hopefully, this trend
will continue.
Patient participants were selected for these visits by their clinicians
based on their suitability, as determined during prior oce visits
as established patients. This was not a controlled study. These data
were gathered in the rst full year of VVV implementation in our
system and are primarily from VVVs for a specialty, so they very likely
do not fully reect the challenges or opportunities of using VVVs
in primary care settings. Surveys are subject to sources of error and
bias; we attempted to minimize these with high-quality methods
and response rate enhancement methods. Lastly, Massachusetts
is not among the 31states that now routinely require third-party
reimbursement for telehealth visits; our health system chose to
support reimbursement to clinicians. It is unknown if the level of
reimbursement created positive or negative incentives. Further study
is needed, including improved models to compensate clinicians, to
measure and dene the appropriate mix of virtual and oce visits,
and to understand the role of other modes of care.
With the inexorable adoption of digital oerings to meet many of the
needs of today’s consumers, it is likely that telehealth will increasingly
be adopted over the next several years. Our data suggest that initial
experiences for patients and clinicians were positive and that, for
most encounters, these VVVs are just as clinically eective and less
expensive for both patient and provider compared with in-person
visits. The fears of distracted, overwhelmed providers and a loss of
human connection between patient and provider have been raised
repeatedly with the rising use of computers in the doctor’s oce.
Interestingly, this issue was not a central concern to participants in
our VVV program, perhaps due to the use of VVVs with established
patients. These visits are not just replacements for in-oce visits; they
hold the possibility of new avenues for care delivery, more frequent
but shorter encounters, and opportunity for earlier intervention.
Further studies are needed to test dierent provider compensation
models to measure and dene the appropriate mix of virtual, oce,
and other modes of care and to establish appropriateness criteria for
the use of telehealth encounters. These issues are all important in
the further use of this technology as part of eective and ecient
patient-centered care and population management.
FIGURE. Patient and Clinician Comparisons of Virtual and Office Visits
Full page
0% 20% 40% 60% 80%
Length of visit required to assess and treat patient (provider)
Amount of time I spend with my clinician (patient)
Comfort I feel sharing personal or private information (patient)
Confidence health concern can be taken care of (patient)
The ability to see a physical problem (provider)
Ability to show clinician a physical problem (patient)
Personal connection I feel with the patient (provider)
Personal connection I feel with clinician during the visit (patient)
Overall quality of the visit (provider)
Overall quality of the visit (patient)
Virtual visit is better No difference Office visit is better Does not apply to me/not answered
44 JANUARY 2019
should further the aims of improving the quality of healthcare
and addressing the Institute of Medicine domains of quality, with
special attention to overcoming existing barriers in access to care,
including the burden of time and nancial costs that patients and
families bear in attending traditional oce visits. n
Author Aliations: Mongan Institute Health Policy Center (KD, EAB, CM),
MGH Center for TeleHealth (JJE, LHS), Department of Neurology (JJE, LHS), and
Department of Psychiatry (JW), Massachusetts General Hospital, Boston, MA; Flare
Capital Partners (SS), Boston, MA; Applied Physics Laboratory, Johns Hopkins
University (ABC), Laurel, MD; Department of Neurology, Johns Hopkins Hospital
and Health System (ABC), Baltimore, MD.
Source of Funding: Massachusetts General Hospital Institutional Funds.
Author Disclosures: Dr Cohen is employed with and provided expert testimony
for Johns Hopkins University Applied Physics Laboratory, which develops health
technology, including telemedicine-related technology. Dr Wozniak’s spouse
has received royalties from UpToDate; consultation fees from Advance Medical,
FlexPharma, Merck, Otsuka, and Gerson Lehman Group; and research support
from RLS Foundation. Dr Schwamm has received a Patient-Centered Outcomes
Research Institute grant on tele–palliative care and is the director of the MGH
Center for TeleHealth. The remaining authors report no relationship or nancial
interest with any entity that would pose a conict of interest with the subject
matter of this article.
Authorship Information: Concept and design (KD, SS, CM, JJE, ABC, JW, LHS);
acquisition of data (KD, EAB, SS, CM, JJE, ABC, JW, LHS); analysis and interpretation
of data (KD, EAB, SS, CM, JJE, ABC, JW, LHS); drafting of the manuscript (KD, EAB,
CM, LHS); critical revision of the manuscript for important intellectual content
(KD, SS, CM, JJE, ABC, JW, LHS); statistical analysis (KD, EAB, CM, JJE, ABC, JW, LHS);
provision of patients or study materials (KD, SS, CM, JJE, ABC, JW, LHS); obtaining
funding (KD, SS, CM, JJE, ABC, JW, LHS); administrative, technical, or logistic support
(KD, SS, CM, JJE, ABC, JW, LHS); and supervision (KD, SS, CM, JJE, ABC, JW, LHS).
Address Correspondence to: Karen Donelan, ScD, EdM, Mongan Institute Health
Policy Center, Massachusetts General Hospital, 100 Cambridge St, Ste 1600, Boston,
MA 02114. Email:
1. Güler NF, Übeyli ED. Theory and applications of telemedicine. J Med Syst. 2002;26(3):199-220.
2. Mehrotra A, Jena AB, Busch AB, Souza J, Uscher-Pines L, Landon BE. Utilization of telemedicine among rural
Medicare beneficiaries. JAMA. 2016;315(18):2015-2016. doi: 10.1001/jama.2016.2186.
3. Perrin A, Jiang J. About a quarter of U.S. adults say they are ‘almost constantly’ online. Pew Research Center
constantly. Published March 14, 2018. Accessed July 12, 2018.
4. Perrin A, Duggan M. Americans’ internet access: 2000-2015. Pew Research Center website.
2015/06/26/americans-internet-access-2000-2015. Published June 26, 2015. Accessed December 21, 2018.
5. Agha Z, Schapira RM, Laud PW, McNutt G, Roter DL. Patient satisfaction with physician-patient communica-
tion during telemedicine. Telemed J E Health. 2009;15(9):830-839. doi: 10.1089/tmj.2009.0030.
6. Perle JG, Langsam LC, Randel A, et al. Attitudes toward psychological telehealth: current and future clinical
psychologists’ opinions of internet-based interventions. J Clin Psychol. 2013;69(1):100-113. doi: 10.1002/jclp.21912.
7. Polinski JM, Barker T, Gagliano N, Sussman A, Brennan TA, Shrank WH. Patients’ satisfaction with and
preference for telehealth visits. J Gen Intern Med. 2015;31(3):269-275. doi: 10.1007/s11606-015-3489-x.
8. Viers BR, Pruthi S, Rivera ME, et al. Are patients willing to engage in telemedicine for their care: a survey
of preuse perceptions and acceptance of remote video visits in a urological patient population. Urology.
2015;85(6):1233-1240. doi: 10.1016/j.urology.2014.12.064.
9. LeRouge CM, Garfield MJ, Hevner AR. Patient perspectives of telemedicine quality. Patient Prefer Adherence.
2015;9:25-40. doi: 10.2147/PPA.S67506.
10. LeRouge C, Hevner A, Collins R, Garfield M, Law D. Telemedicine encounter quality: comparing patient and
provider perspectives of a socio-technical system. Presented at: 37th Annual Hawaii International Conference
on System Sciences; January 5-8, 2004; Big Island, HI. doi: 10.1109/HICSS.2004.1265375.
11. Weinstein RS, Lopez AM, Krupinski EA, et al. Integrating telemedicine and telehealth: putting it all together.
Stud Health Technol Inform. 2008;131:23-38.
12. Meyers D, Peikes D, Genevro J, et al. The roles of patient-centered medical homes and accountable care
organizations in coordinating patient care [AHRQ publication no. 11-M0005-EF]. Agency for Healthcare
Research and Quality website.
And%20ACOs%20in%20Coordinating%20Patient%20Care.pdf. Published December 2010. Accessed
December 21, 2018.
13. Bao Y, Casalino LP, Pincus HA. Behavioral health and health care reform models: patient-centered
medical home, health home, and accountable care organization. J Behav Health Serv Res. 2013;40(1):121-132.
14. Adler-Milstein J, Kvedar J, Bates DW. Telehealth among US hospitals: several factors, including
state reimbursement and licensure policies, influence adoption. Health Aff (Millwood). 2014;33(2):207-215.
15. An overview of version 3.0 of the CAHPS Clinician & Group Survey. Agency for Healthcare Research and
Quality website.
Published June 17, 2015. Accessed December 21, 2018.
16. Kvedar J, Coye MJ, Everett W. Connected health: a review of technologies and strategies to improve patient
care with telemedicine and telehealth. Health Aff (Millwood). 2014;33(2):194-199.
17. Kim YS. Telemedicine in the USA with focus on clinical applications and issues. Yonsei Med J.
2004;45(5):761-775. doi: 10.3349/ymj.2004.45.5.761.
18. Health policy brief: telehealth parity laws. Health Affairs Blog website.
hblog20160815.056155/full. Published August 15, 2016. Accessed December 21, 2018.
19. Schwamm LH. Telehealth: seven strategies to successfully implement disruptive technology and transform
health care. Health Aff (Millwood). 2014;33(2):200-206. doi: 10.1377/hlthaff.2013.1021.
Visit to download PDF and eAppendix
eAppendix Table. Respondent Characteristics
(N = 254)
135 (53.1%)
119 (46.9%)
Age, years
68 (26.8%)
51 (20.1%)
79 (31.1%)
56 (22.0%)
White, non-Hispanic
220 (86.6%)
34 (13.4%)
Insurance type
Private insurance
195 (76.8%)
12 (4.7%)
41 (16.1%)
Patient payments
6 (2.4%)
Service or department
113 (44.5%)
92 (36.2%)
30 (11.8%)
19 (7.5%)
Device used for virtual video visit
Desktop computer
44 (17.3%)
Laptop computer
146 (57.5%)
56 (22.1%)
2 (0.8%)
3 (1.2%)
Travel time
How long does it take you to travel to MGH for office visits?
40 minutes
63 (24.8%)
41-59 minutes
54 (21.3%)
60-89 minutes
59 (23.2%)
90 minutes
66 (26.0%)
Not answered
12 (4.7%)
eAppendix Figure 1. TeleHealth Patients’ Perceptions of Virtual Video Visits vs Office Visits
Source: Data from MGH TeleHealth Patient Survey.
eAppendix Figure 2. TeleHealth Clinicians’ Perception of Virtual Video Visits vs Office Visits
Source: Data from MGH TeleHealth Clinician Survey.
0% 20% 40 % 60% 80% 100%
Overall quality of the visit
Personal connection I feel with the patient
The ability to see a physical problem
Ease of ordering tests for the patient
Ease of accessing patient records during the visit
Ease of scheduling followup visits
Workflow outside of the visit (before and after)
Length of visit required to assess and treat patient
Efficiency of the visit
Timely patient access to followup appointments
Virtual visit is bette r No difference Office visit is better Does not apply to me
eAppendix Figure 3. TeleHealth Patients’ Willingness to Pay for Virtual Video Visit
Source: Data from MGH TeleHealth Patient Survey.
020 40 60 80 100
Full cost of visit
Copay $26-50
Copay $10-25
Yes, Definitely Yes, Somewhat No Don't know/Not answered
... Research prior to the pandemic found that telemedicine consistently demonstrated treatment efficacy and patient acceptability that was comparable to in-person care. For instance, an evaluation of a telemedicine pilot program across five specialties, including psychiatry, found that the majority of patients (63%) and clinicians (59%) did not differentiate between virtual and office visits in terms of the overall quality of the visit (9). Subsequent studies continued to report overall high approval of telemedicine by both patients and providers, with Hubley et al. (10) noting telemedicine's advantages of convenience and cost while maintaining comparable results to in-person appointments (3,(10)(11)(12)(13). ...
... In contrast to pre-pandemic efforts, pandemic-era telepsychiatry was adopted rapidly and often with minimal planning or training, risking implementation of telepsychiatry in a manner that was neither sustainable nor on par with in-person care (7,15). However, evaluations of telepsychiatry during this period continued to report high levels of satisfaction among patients and providers (6,9,(16)(17)(18)(19)(20)(21). Both groups identified many benefits, including ease of transportation and scheduling, lowered infection risk, and fewer cancellations (16,17). ...
... The survey was developed based on a literature review of prior surveys on telemedicine in tandem with feedback from providers across the Johns Hopkins Department of Psychiatry and Behavioral Sciences. Multiple items were adapted for use in this survey from previously validated questionnaires, including the Telemedicine Satisfaction Scale (23); the Telemedicine Usability Questionnaire (24); the System Usability Scale (25); the mHealth App Usability Questionnaire (26); the Consumer Assessment of Healthcare Providers and Systems (CAHPS) Experience of Care and Health Outcomes Survey (ECHO) Version 3.0, including the Managed Behavioral Health Organization and the Managed Care Organization Supplemental Surveys (27,28); the University of Washington Telemedicine Patient Satisfaction Survey (29); and an adapted CAHPS survey designed by Donelan et al. (9). ...
Full-text available
Introduction The objective of this study was to characterize the experiences and overall satisfaction of patients and providers with the March 2020 transition to telehealth in a psychiatric setting (telepsychiatry). The study also investigated how socio-demographic and clinical characteristics impact an individual’s experiences and satisfaction with telepsychiatry. Methods Responses were collected from 604 patients and 154 providers engaged in clinical care at one of three participating Johns Hopkins Medicine outpatient psychiatric clinics between January 2020–March 2021. Survey data were collected by self-report via Qualtrics or telephone follow-up. Results Respondents were predominately female and White. Over 70% of patients and providers were generally satisfied with telepsychiatry. However, providers were more likely to favor in-person care over telepsychiatry for post-pandemic care 48% to 17% respectively, while 35% rated both modalities equivalently. Patients were more evenly divided with 45% preferring telepsychiatry compared to 42% for in-person care, and only 13% rating them equivalently. Among providers, technical difficulties were significantly associated with both less satisfaction and lower preference for telepsychiatry [odds ratio for satisfaction (OR S ) = 0.12; odds ratio for preference (OR P ) = 0.13]. For patients, factors significantly associated with both lower satisfaction and lower preference for telepsychiatry included technical difficulties (OR S = 0.20; OR P = 0.41), unstable access to the internet (OR S = 0.46; OR P = 0.50), worsening depression (OR S = 0.38; OR P = 0.36), and worsening anxiety (OR S = 0.41; OR P = 0.40). Factors associated with greater satisfaction and higher preference for telepsychiatry among patients included higher education (OR S = 2.13; OR P = 1.96) and a decrease in technical difficulties over time (OR S = 2.86; OR P = 2.35). Discussion Patients and providers were satisfied with telepsychiatry. However, there were greater differences between them in preferences for continuing to use telepsychiatry post-pandemic. These findings highlight factors that influence patient and provider preferences and should be addressed to optimize the use of telepsychiatry in the future.
... Regardless of technology access, patients also have personal preferences for the type of telemedicine visit they would choose, which may vary by specific concern. 13 Some patients prefer telephone to limit the need to prepare themselves or their surroundings, whereas others value the visual information conveyed 14 and increased personal interaction of a video visit. ...
Background Patient perceptions of primary care telephone and video telemedicine and whether COVID-19 pandemic-related telemedicine exposure shifted patients’ visit preference is unknown. Objectives We examined patient surveys to understand the health care experience of patients seeking primary care through telemedicine and how patients expected their preferences to shift as a result of the COVID-19 pandemic. Research Design/Subjects In an integrated delivery system that shifted to a “telemedicine-first” health care model during the COVID-19 pandemic, we sampled monthly and collected 1000 surveys from adults with primary care telemedicine visits scheduled through the online patient portal between 3/16/2020 and 10/31/2020. Measures Participants reported their preferred primary care visit modality (telephone, video, or in-person visits) across 3 time points: before, during and (hypothetically) after the COVID-19 pandemic, and reported their general assessment of primary care visits during the pandemic. Results The majority of participants preferred in-person visits before (69%) and after the COVID-19 pandemic (57%). However, most participants reported a preference for telemedicine visits during the pandemic and continue to prefer telemedicine visits at a 12% higher rate post-pandemic. Many participants (63%) expressed interest in using telemedicine at least some of the time. Among participants reporting a recent telemedicine visit, 85% agreed that the visit addressed their health needs. Conclusion As primary care visit modality preferences continue to evolve, patients anticipate that they will continue to prefer telemedicine visits, both video and telephone, at an increased rate than before the COVID-19 pandemic.
... There is need to better define for which patients and in which medical situations video can become safe and efficient. [1][2][3][4][5][6][7][8][9][10][11][12][13][14][15][16][17][18]. However, most of these studies were conducted before the SARS-Cov2 pandemic, and in contexts where TLM was already welldeveloped. ...
... During the COVID-19 pandemic, remote consultations have markedly increased in importance [6]. However, a prerequisite for widespread adoption of telemedicine is that it must favorably compete with in-person consultations on several objective measures, including effectiveness [7,8], availability [9,10], and costs [11]. During the COVID-19 pandemic, video-and audio-only visits were reimbursed even at the same rate as face-to-face visits in the United States [12]. ...
Full-text available
Background Teledermatology is currently finding its place in modern health care worldwide as a rapidly evolving field. Objective The aim of this study was to investigate the acceptance of teledermatology compared to in-person consultation from the perspective of patients and professionals. Methods This multicenter, cross-sectional pilot study was performed at secondary and tertiary referral centers of dermatology in Switzerland from August 2019 to January 2020. A customized questionnaire addressing demographics and educational data, experience with telemedicine, and presumed willingness to replace in-patient consultations with teledermatology was completed by dermatological patients, dermatologists, and health care workers in dermatology. ResultsAmong a total of 664 participants, the ones with previous telemedicine experience (171/664, 25.8%) indicated a high level of overall experience with it (patients: 73/106, 68.9%, dermatologists: 6/8, 75.0%, and health care workers: 27/34, 79.4%). Patients, dermatologists, and health care workers were most likely willing to replace in-person consultations with teledermatology for minor health issues (353/512, 68.9%; 37/45, 82.2%; and 89/107, 83.2%, respectively). We observed a higher preference for telemedicine among individuals who have already used telemedicine (patients: P
... 22 It must however be noted that telehealth in dentistry is ideal for concerns that do not require direct hands-on care, but it does not eliminate the need for an in-person visit in many other situations such as emergency den-tal needs, comprehensive and routine dental care and treatment via a thorough clinical examination, dental radiographs, and other diagnostic tests. [23][24][25] Therefore, it is imperative that a provider pay careful attention to patient needs and use their clinical judgment to determine which patients can be attended to through telehealth. [30][31][32] Regarding the type of dental specialty that may benefit the most from the application of telehealth, the majority of respondents selected dental public health, followed by oral maxillofacial radiology, oral medicine, and orofacial pain. ...
Full-text available
Purpose: The objective of this study was to assess provider attitudes and opinions regarding telehealth in the dental school environment. Method: A survey was developed and validated and was sent to 849 predoctoral students, postdoctoral students (residents), and faculty at a single dental school. It consisted of 13 questions regarding the participants' professional backgrounds, opinions, and attitudes toward telehealth. The survey opened on November 16, 2021, and remained open for 6 weeks. Results: Of 849 survey recipients, 163 (19%) responded. Among 161 usable surveys, 90 (56%) were predoctoral students, 42 (26%) were postdoctoral students, and 29 (18%) were faculty. Fifty-four percent reported having completed at least one telehealth visit. Among this subset, 80% strongly agreed or agreed that telehealth is a good adjunct in providing care; 74% strongly agreed or agreed that telehealth has improved communication with patients. Conclusion: Most dental providers reported positive opinions and attitudes regarding telehealth's ability to improve communication and serve as an adjunct to providing care. Practical implications: In the right circumstances, telehealth offers an alternative to traditional oral healthcare delivery methods. Based on the perceptions of dental providers, the use of telehealth may also be beneficial in combination with traditional approaches in the dental school environment.
... Niewątpliwie specjaliści w głównej mierze zwracają uwagę na zachowanie profesjonalności podczas wizyt zdalnych, a także niepopełnianie błędów medycznych jak i kompleksową diagnozę chorego [6]. Z kolei pacjenci uważają za kluczowe czas oraz koszty związane z podróżą, konieczność brania urlopu w pracy w celu skorzystania z wizyty lekarskiej jak i dostosowanie się do wymogów placówek medycznych [7]. W tym badaniu autorzy zapytali o opinię na temat telepsychiatrii pacjentów korzystających z usług poradni psychiatrycznej. ...
Full-text available
BACKGROUND: Telemedicine is among the most modern branches of medicine. In the field of mental health, telepsychiatry makes it possible to replace the traditional conversation with a specialist with an e-visit. With the development of remote services, qualitative studies evaluating this type of service have begun to be conducted. The studies involve both patients and clinicians. The purpose of this study is to show the advantages perceived by patients who use telepsychiatry services, as well as concerns that may discourage further use of digital therapy. The study also includes an evaluation of telemedicine services. Material and methods: The authors created a proprietary structured questionnaire that consisted of two parts. The first concerned sociodemographic data, while the second addressed the subject of patients' evaluation with the use of telepsychiatry services, possible difficulties during e-visits and satisfaction with this type of consultation. Before completing the survey, patients filled out informed consent. The survey was conducted from November 2022 to May 2023. Results: The final group of respondents was formed by 432 people. The largest group of respondents were patients with the diagnosis: affective disorders - 24.07%. The vast majority of respondents - 81.94% - indicated the possibility of teleportation from anywhere in the world as the greatest advantage of telepsychiatry. Another advantage is not having to take time off from work or school - 78.94%. Major disadvantages included: limited treatment methods (71.07% of respondents), made it more difficult to build a therapeutic alliance 59.03%, privacy and cybersecurity concerns 43.06%. Overall, patients rate telepsychiatry well - 66% of respondents were satisfied. Conclusions: Telepsychiatry is well rated among most patients. More research is needed to develop clear guidelines for digital therapy. Patients receiving remote therapy should be screened for the development of addiction to mobile devices and the Internet.
... There is need to better define for which patients and in which medical situations video can become safe and efficient. [1][2][3][4][5][6][7][8][9][10][11][12][13][14][15][16][17][18]. However, most of these studies were conducted before the SARS-Cov2 pandemic, and in contexts where TLM was already welldeveloped. ...
Full-text available
BACKGROUND While the use of telemedicine (TLM) increased worldwide during the early phases of the COVID-19 pandemic, little is known about the use and acceptance of TLM post-COVID-19 pandemic. OBJECTIVE To evaluate patients’ and physicians’ self-reported use, preferences and acceptability of different types of TLM after the initial phases of the COVID-19 pandemic METHODS We conducted a cross-sectional survey among patients and physicians in Geneva, Switzerland between September 2021 and January 2022. Patients in waiting rooms of both private and public medical centres and emergency services were invited to answer an online questionnaire. Physicians working in private and public settings were invited by email to answer a similar questionnaire. The questionnaires assessed participants’ socio-demographics and digital literacy; self-reported use of TLM; as well as preferences and acceptability of TLM for different clinical situations RESULTS 567 patients (55% women) and 448 physicians (51% women, 50% in private practice) responded to the questionnaire. Patients and physicians generally preferred phone over other TLM formats (46.5% and 55.2%) and considered it to be acceptable for most medical situations. Email was acceptable for communicating exam results (73.6 and 68.8%) and medical certificates (67.7 and 66.2%) and video was considered acceptable for psychological support by 53.2% of patients and 64.3% of physicians. Older age was associated with lower acceptability of video for both patients and physicians (OR 0.03 95%CI 0.00-0.33) and (OR 0.23 95%CI 0.08-0.66) while prior use of video was positively associated with video acceptability (OR 3.16 95%CI 1.84-5.43) and (OR 3.34 CI95%2.91-5.54). Psychiatrists and hospital physicians were more likely to consider video to be acceptable (OR 10.79 (95%CI 3.96-29.3) and 3.97 (95%CI 2.23-7.6). CONCLUSIONS Despite the development of video, acceptability of video remains lower than phone for most health issues or patient requests. There is need to better define for which patients and in which medical situations video can become safe and efficient. CLINICALTRIAL Because we collected no personal health information, the study was granted a waiver from ethical approval by the Ethical Committee of the Canton of Geneva (article 2 of the Swiss Federal Act on Research involving Human Beings).
... Our findings are in line with published studies that report high levels of satisfaction among patients and health care providers who participated in telehealth in the primary care and specialized settings. [25][26][27][28][29] Both health care and patient participants in our study concur that telehealth may not cater to older patients and those who lack digital literacy. Research has shown that higher age, lower academic qualifications, and lower computer literacy can reduce a patient's willingness to adopt mobile health technologies, 30,31 with younger and female patients emerging as early adopters of virtual consultations in one study. ...
Full-text available
Purpose Although the financial burden and impact of a cancer diagnosis has been widely described in international literature, less understood is the availability and accessibility of services to ameliorate this need. This study reports the experiences of Australian lung cancer patients and health professionals delivering care, regarding factors that exacerbate and mitigate financial stress, and availability and accessibility of services to support people following a cancer diagnosis. Methods Qualitative semi-structured interviews with twenty-three lung cancer patients attending two metropolitan tertiary health services and eleven health professionals delivering care were undertaken during July–August 2021. Results Neither health service systematically screened for financial toxicity nor routinely provided information regarding potential financial impacts during consultations. Patients experienced lengthy delays in accessing welfare supports, provoking financial stress and worry. Health professionals reported limited resources and referral services to support patients with financial need; this was especially problematic for patients with lung cancer. They described its psychological impact on patients and their family members or carers and warned of its impact on ability to adhere to treatment. Conclusion Available and accessibility of services addressing financial toxicity in Australian lung cancer patients is inadequate. Although financial stress is a common, distressing problem, health professionals feel hampered in their ability to help due to limited service availability. Left unaddressed, financial toxicity can impact treatment adherence, directly influencing health outcomes, and increase risk of poverty, amplifying social inequities. Findings highlight opportunity for actionable interventions like financial consent and routine screening and discussion of financial toxicity across care pathways.
The COVID-19 pandemic spurred a widespread shift to remotely delivered health services. Telehealth has shown promise in making healthcare more accessible. Little research has looked at the effects of this change on access to healthcare for Latinx immigrants. This qualitative study explored the shift to remote services during the COVID-19 pandemic in a new immigrant destination. Authors interviewed 23 service providers to assess if telehealth increased access to healthcare for Latinx immigrants. Results showed that telehealth improved access to services overall. Still, barriers to care remained. Immigrants experienced (a) limited access to technology and low digital literacy, (b) lack of privacy during the provision of services, (c) inability to utilize certain digital platforms due to confidentiality regulations, and (d) decreased quality of services. Findings suggest that telehealth is a promising modality to decrease healthcare disparities, but providers need to thoughtfully address barriers unique to Latinx immigrants to ensure their full participation.
Full-text available
The purpose of this study was to explore the quality attributes required for effective telemedicine encounters from the perspective of the patient. We used a multi-method (direct observation, focus groups, survey) field study to collect data from patients who had experienced telemedicine encounters. Multi-perspectives (researcher and provider) were used to interpret a rich set of data from both a research and practice perspective. The result of this field study is a taxonomy of quality attributes for telemedicine service encounters that prioritizes the attributes from the patient perspective. We identify opportunities to control the level of quality for each attribute (ie, who is responsible for control of each attribute and when control can be exerted in relation to the encounter process). This analysis reveals that many quality attributes are in the hands of various stakeholders, and all attributes can be addressed proactively to some degree before the encounter begins. Identification of the quality attributes important to a telemedicine encounter from a patient perspective enables one to better design telemedicine encounters. This preliminary work not only identifies such attributes, but also ascertains who is best able to address quality issues prior to an encounter. For practitioners, explicit representation of the quality attributes of technology-based systems and processes and insight on controlling key attributes are essential to implementation, utilization, management, and common understanding.
Full-text available
Discussions of health care delivery and payment reforms have largely been silent about how behavioral health could be incorporated into reform initiatives. This paper draws attention to four patient populations defined by the severity of their behavioral health conditions and insurance status. It discusses the potentials and limitations of three prominent models promoted by the Affordable Care Act to serve populations with behavioral health conditions: the Patient-Centered Medical Home, the Health Home initiative within Medicaid, and the Accountable Care Organization. To incorporate behavioral health into health reform, policymakers and practitioners may consider embedding in the reform efforts explicit tools-accountability measures and payment designs-to improve access to and quality of care for patients with behavioral health needs.
Conference Paper
Full-text available
The effectiveness of the telemedicine encounter is dependent on the use of state-of-the-art technology and the quality of the technology-based interactions. We take a socio-technical approach to understanding quality during telemedicine encounters. This approach has not been well studied in telemedicine service encounter research. To enrich understanding, we use a multimethod (direct observation, interview, focus group, survey) field study to collect and interpret a rich set of data. We conduct this study from two perspectives. First, we focus on the perceptions of the medical providers (e.g. physicians) who directly use the technology and are accountable for patient care. We then compare provider perspectives to those of patients, who act as indirect users of telemedicine technology and are the ultimate consumers of health care services provided via telemedicine. The result of this field study is a comparative framework of quality attributes for telemedicine service encounters that prioritizes the attributes from the provider and patient perspectives.
This study describes trends in telemedicine utilization in Medicare from 2004-2013.Telemedicine may increase access and improve quality, particularly in rural areas.1 Because inadequate reimbursement may limit telemedicine use, 29 states have passed telemedicine parity laws mandating that commercial insurers reimburse telemedicine visits.2 In contrast, Medicare limits telemedicine reimbursement to select live video encounters with the patient at a clinic or facility in a rural area.3 Federal legislation has been proposed to expand Medicare telemedicine coverage. To inform the debate regarding telemedicine expansion, we describe trends in telemedicine utilization in Medicare from 2004-2013.
One-quarter of U.S. patients do not have a primary care provider or do not have complete access to one. Work and personal responsibilities also compete with finding convenient, accessible care. Telehealth services facilitate patients' access to care, but whether patients are satisfied with telehealth is unclear. We assessed patients' satisfaction with and preference for telehealth visits in a telehealth program at CVS MinuteClinics. Cross-sectional patient satisfaction survey. Patients were aged ≥18 years, presented at a MinuteClinic offering telehealth in January-September 2014, had symptoms suitable for telehealth consultation, and agreed to a telehealth visit when the on-site practitioner was busy. Patients reported their age, gender, and whether they had health insurance and/or a primary care provider. Patients rated their satisfaction with seeing diagnostic images, hearing and seeing the remote practitioner, the assisting on-site nurse's capability, quality of care, convenience, and overall understanding. Patients ranked telehealth visits compared to traditional ones: better (defined as preferring telehealth), just as good (defined as liking telehealth), or worse. Predictors of preferring or liking telehealth were assessed via multivariate logistic regression. In total, 1734 (54 %) of 3303 patients completed the survey: 70 % were women, and 41 % had no usual place of care. Between 94 and 99 % reported being "very satisfied" with all telehealth attributes. One-third preferred a telehealth visit to a traditional in-person visit. An additional 57 % liked telehealth. Lack of medical insurance increased the odds of preferring telehealth (OR = 0.83, 95 % CI, 0.72-0.97). Predictors of liking telehealth were female gender (OR = 1.68, 1.04-2.72) and being very satisfied with their overall understanding of telehealth (OR = 2.76, 1.84-4.15), quality of care received (OR = 2.34, 1.42-3.87), and telehealth's convenience (OR = 2.87, 1.09-7.94) CONCLUSIONS: Patients reported high satisfaction with their telehealth experience. Convenience and perceived quality of care were important to patients, suggesting that telehealth may facilitate access to care.
To examine patient preuse acceptance and perceptions of video visit (VV) technology within an ambulatory urology setting. Patients treated by a single urology department from January to June 2013 were identified. A Web-based survey was conducted evaluating patient demographics, preuse perceptions, and acceptance of VV. In total, 1378 patients (25%) completed the survey; of which 868 (63%) were willing to participate in VV for their urologic care. Compared with patients "unlikely," those "likely" to participate in VV were younger (62 vs 65 years), had a college education (77% vs 65%), had previous exposure to videoconference technology (57% vs 38%), were more comfortable discussing new symptoms (56% vs 30%) and sensitive information (48% vs 27%), and played an active role in their healthcare (65% vs 54%). Moreover, patients willing to participate in VV traveled larger distances (>90 minutes; 69% vs 58%), missed more work (>1 day; 39% vs 29%), and incurred greater expenses for their care (>$250; 52% vs 25%) relative to those who were unlikely. After controlling for associated patient characteristics, a high level of agreement among urology-specific questions remained independently associated with greater likelihood of VV acceptance among both male and female patients. A large proportion of patients are willing to participate in VV for their urologic care. This may have significant implications by reducing costs and increasing access to, and quality of, health care services. These findings may assist urologists in strategically directing future efforts to reach diverse patient populations via VV technology. Copyright © 2015 Elsevier Inc. All rights reserved.
Telehealth is widely believed to hold great potential to improve access to, and increase the value of, health care. Gaining a better understanding of why some hospitals adopt telehealth technologies while others do not is critically important. We examined factors associated with telehealth adoption among US hospitals. Data from the Information Technology Supplement to the American Hospital Association's 2012 annual survey of acute care hospitals show that 42 percent of US hospitals have telehealth capabilities. Hospitals more likely to have telehealth capabilities are teaching hospitals, those equipped with additional advanced medical technology, those that are members of a larger system, and those that are nonprofit institutions. Rates of hospital telehealth adoption by state vary substantially and are associated with differences in state policy. Policies that promote private payer reimbursement for telehealth are associated with greater likelihood of telehealth adoption, while policies that require out-of-state providers to have a special license to provide telehealth services reduce the likelihood of adoption. Our findings suggest steps that policy makers can take to achieve greater adoption of telehealth by hospitals.
"Telehealth" refers to the use of electronic services to support a broad range of remote services, such as patient care, education, and monitoring. Telehealth must be integrated into traditional ambulatory and hospital-based practices if it is to achieve its full potential, including addressing the six domains of care quality defined by the Institute of Medicine: safe, effective, patient-centered, timely, efficient, and equitable. Telehealth is a disruptive technology that appears to threaten traditional health care delivery but has the potential to reform and transform the industry by reducing costs and increasing quality and patient satisfaction. This article outlines seven strategies critical to successful telehealth implementation: understanding patients' and providers' expectations, untethering telehealth from traditional revenue expectations, deconstructing the traditional health care encounter, being open to discovery, being mindful of the importance of space, redesigning care to improve value in health care, and being bold and visionary.
With the advent of national health reform, millions more Americans are gaining access to a health care system that is struggling to provide high-quality care at reduced costs. The increasing adoption of electronic technologies is widely recognized as a key strategy for making health care more cost-effective. This article examines the concept of connected health as an overarching structure for telemedicine and telehealth, and it provides examples of its value to professionals as well as patients. Policy makers, academe, patient advocacy groups, and private-sector organizations need to create partnerships to rapidly test, evaluate, deploy, and pay for new care models that use telemedicine.
Objectives: The current study explored differences in acceptance of telehealth interventions amongst currently licensed and future clinicians with a focus on web camera-based intervention. The influence of theoretical orientation was also assessed. Method: An online survey assessed 717 participants comprising 409 licensed psychologists (40.8% female, mean age = 56.57, standard deviation [SD] = 11.01) and 308 doctoral-level students (78.9% female, mean age = 27.66, SD = 5.9) across domains of endorsement and rejection. Results: Binary logistic regression indicated no significant difference between currently licensed and future psychologists in their endorsement of telehealth modalities. Cognitive-behavioral, cognitive, behavioral, and systems psychologists were significantly more accepting of telehealth interventions than were dynamic/analytic or existential therapists. Conclusions: Increasing exposure to telehealth through education as well as continued research on efficacy for specific diagnoses may help psychologists to more effectively determine whether telehealth is the "best fit" for both clinician and client.