How Primary Care Physicians Experience Telehealth: An International Comparison

Introduction

In the early months of the COVID-19 pandemic, lockdowns and social-distancing rules caused in-person primary care consultations to plummet.¹ Many clinicians opted for telehealth — the provision of clinical and other health-related care by video or telephone — as an alternative to face-to-face office visits. Governments in many countries, including the United States, facilitated this shift by loosening regulations and enhancing payment and reimbursement for telehealth services.²

Telehealth’s popularity with patients during COVID-19 suggests it will have continuing utility beyond the pandemic.³ With the global shortage of primary care physicians and exposed inequities in access to health care, telehealth may turn out to be a better way to deliver critical health services to underserved populations.⁴

While there is a rich body of research describing the benefits and challenges of telehealth for patients, providers’ perspectives have been far less explored. Their experiences are critical to future policy decisions about financing, regulating, and possibly restricting telehealth services.⁵ This brief presents findings from the 2022 Commonwealth Fund International Health Policy Survey of Primary Care Physicians, conducted in 10 high-income countries from February through September 2022, to explore how primary care physicians view the ease of use and effectiveness of telehealth after the height of the COVID-19 pandemic. Our analysis is largely limited to those physicians who reported using telehealth, whether through telephone or video, at least some of the time.

Survey Findings

Two years into the pandemic, the majority of primary care physicians in half of the countries we surveyed reported seeing more than a quarter of their patients through telehealth in a typical week via telephone or video calls (see Table 1 for percentages by country). In the United States, the majority of physicians saw fewer than a quarter of their patients through telehealth, and, consistent with prior research, nearly one in five U.S. physicians reported not using telehealth at all.⁶ In the United Kingdom, more than a quarter of physicians said that on a weekly basis, they see most of their patients via telehealth.

The majority of primary care physicians in eight of the 10 countries we surveyed, including the United States, reported that implementing a telehealth platform was “somewhat” or “very” easy (see Table 2 for country breakdowns). But only three of 10 German physicians and four of 10 Swiss physicians reported the same.

Implementation challenges may be partly related to cost. Our survey shows that in Germany, physicians were also more likely to report the added expenses of implementing and maintaining their telehealth platforms as a “major” challenge (Table 1).

In the U.S., Canada, the U.K., and Australia, the vast majority of primary care physicians reported telehealth improved the timeliness of care either “to a great extent” or “to some extent.” In contrast, less than half of physicians in Switzerland and Sweden, and only one of five in Germany, reported that telehealth improved the timeliness of care.

Timeliness of care, however, does not necessarily translate to improved quality of care. Among providers in all countries who reported telehealth improved timeliness, fewer than one of five also said they saw an improvement in the quality of patient care they were able to deliver since the start of the COVID-19 pandemic (data not shown).

The use of telehealth made it possible for a large majority of physicians in the U.S. and Australia who use it to offset financial losses related to the pandemic. Few physicians in Germany reported the same.

While the majority of primary care physicians who use telehealth in the U.S. and Australia reported that it offset potential losses, nearly one of three physicians in the U.S., and nearly half in Australia, said low or no insurance reimbursement for telehealth visits was a major challenge for their practice (Table 1).

With the onset of the pandemic, mental health needs spiked globally.⁷ Physicians in the U.K., Australia, Canada, and the U.S. most often reported that telehealth allowed their practice to assess mental and behavioral health needs of their patients to either “a great extent” or “to some extent.” In contrast, less than one-third of physicians in Germany and France considered telehealth to be an effective tool for assessing mental and behavioral health needs.

Except for Germany and Switzerland, more than half of primary care physicians who use telehealth — including three of four in the United States — reported they were satisfied with practicing it.

Discussion

According to primary care physicians in most of the countries we surveyed, telehealth has had important benefits: offsetting financial losses during the pandemic, improving the timeliness of care, and allowing doctors to assess patients’ mental and behavioral health needs more effectively. Still, telehealth uptake has varied from country to country.

In the Commonwealth Fund survey, one in three U.S. primary care physicians reported that low or no reimbursement for telehealth visits is a major challenge in their practice — additional evidence that the United States underinvests in primary care, particularly compared to other high-income countries. With the health care system already facing a primary care shortage and a burned-out workforce, it will be critical to ensure that primary care physicians are adequately paid to meet the health care demands of a growing population.⁸

For telehealth use to make further gains, policymakers and health system leaders will need to understand which telehealth services, and which forms of telehealth, are most frequently used by providers and patients.⁹ In the United States, for example, higher-income, younger, and white adults are more likely to use video services when they use telehealth care, while lower-income and Black and Hispanic adults are more likely to use audio services.¹⁰ Research also showed continuous growth in telehealth visits for treatment of mental health and substance use issues during the pandemic, particularly among rural Americans.¹¹ Evidence from the United Kingdom similarly suggests telehealth has improved access to mental health care for people in rural regions, which constitute much of the country.¹² In all nations, concerted data collection efforts that track these measures could help policymakers maximize telehealth’s benefits and reduce health disparities.

In several countries, recent shifts in government financing and regulations have created uncertainty about the future of telehealth. While the U.S. Congress has extended several pandemic-era rules to make telehealth visits more accessible for both providers and patients — like allowing Medicare beneficiaries to receive primary care telehealth services without geographic restrictions — not all changes are permanent, and the decision to extend other longer-term policies may be left up to individual states.¹³ Policymakers in other countries may face similar challenges, potentially affecting the “new normal” of blended in-person and telehealth visits.¹⁴

Finally, it should be noted that we were unable to identify the reasons for variations between countries, if physicians’ telehealth experiences improved the quality of care they delivered, or if telehealth is being delivered in the most appropriate and efficient ways. More qualitative research will be needed in each of these areas to properly assess the benefits and drawbacks of increased telehealth use.¹⁵