Background:

Understanding the dynamics of telehealth utilization, specifically the use of virtual consultations, is critical in assessing healthcare system resilience and adaptability in times of crisis and beyond. We sought to describe the availability of virtual consultations before and during the COVID-19 pandemic, and identify factors associated with their availability.

Research questions:

(1) To describe the availability and use of telephone, video and human chat consultations before and during the COVID-19 pandemic period, and (2) identify factors associated with their availability.

Method:

Primary Care Physicians (PCPs) from 20 upper-middle and high-income countries completed a cross-sectional online survey between June and September 2020. Responses were collected from PCPs who answered questions on availability of virtual consultation technologies (chat, video, or telephone consultations) before or during the COVID-19 pandemic. The percentage of PCPs with the technology available, and hours of use of each of the technologies, were examined for both time periods. Factors associated with availability were investigated using chi-squared tests.

Results:

A total of 1,370 PCPs were included in this study. Before and during the pandemic, telephone consultations were the most frequently available solution (73.1% and 90.4%, respectively). Statistically significant increases were observed in the 3 technologies during the pandemic. Largest absolute increases in availability were observed for video consultations (+39.5%, p<0.0001), followed by telephone consultations (+17.3%, p<0.0001) and chat consultations (+8.6%, p<0.0001).

Conclusions:

Our study demonstrates the transformative impact of the COVID-19 pandemic on the availability and utilization of virtual consultations among PCPs. Video consultations demonstrated the greatest growth, and their uptake was mainly impacted by training and availability of digital infrastructure. Addressing barriers to access, including disparities in digital literacy and technological resources, will be imperative in ensuring equitable delivery of telehealth services. 

Points for discussion: