By Betia Zeng

Chronic diseases are the leading causes of disability and death in the U.S., accounting for over 1.7 million deaths annually. The total cost of chronic disease totals $3.7 trillion annually, including healthcare costs and lost economic productivity. Having multiple chronic diseases (two or more conditions simultaneously) often results in increased health burdens and high expenditures. Patients with five or more chronic conditions, (i.e., 12% of the total population in 2014) account for 41% of total healthcare spending in the U.S. (Buttorff et al., 2017). Chronic disease patients have a higher need for medical care as they require ongoing treatment and care of their condition; thus, as the number of chronic diseases increases, so does healthcare service utilization of all types.

Telehealth, in which health services are delivered remotely through audio and video technology, is a cost-effective strategy to improve access to care for patients. Telehealth alleviates many barriers associated with traditional healthcare services for chronic disease patients; it addresses provider shortages and eliminates patient travel while allowing for comparable quality of care. Telehealth has allowed for positive outcomes for hypertension, stroke, heart failure, diabetes, and chronic kidney disease. Previous studies have shown that chronic disease patients are generally satisfied with telehealth experiences due to perceived safety and convenience. With the increasing prevalence of chronic disease in the U.S. and the associated cost crisis, it is important to understand how telehealth can alleviate barriers to care and improve outcomes for those with chronic illness. We conducted a quantitative analysis to understand whether the patient experiences with telehealth among U.S. adults vary by chronic disease status.

The data were extracted from the COVID-19 Impact Survey, an observational, cross-sectional study conducted on 1,500 adults in the United States between February and April 2021. Participants were recruited through Qualtrics research panel service, an online study participant recruitment service platform. Qualtrics then identified eligible participants and randomly selected a diverse sample to participate in the study, providing access to the self-administered questionnaire through an email invitation. Participants were asked to rate their experience at their most recent telehealth visit in two ways – ease of communication and healthcare quality.

The relationship between chronic disease and telehealth experience differed based on the measure used. Consistent with previous studies, a majority (79%) of chronic disease patients expressed that they found it easy to communicate with the healthcare provider. However, the study did show a clear correlation between patients with multiple chronic diseases and a likelihood of experiencing difficulty communicating via telehealth. Adults with three or more chronic conditions were twice as likely to rate their ease of communication as “very or somewhat hard” compared to adults with no chronic diseases (10% and 5%, respectively) (p < 0.05). This aligns with expectations that chronic disease patients are more likely to experience difficulty during their healthcare visits. In terms of the perception of healthcare quality, no differences were observed as the number of diseases increased. While there is not much recent literature documenting this relationship in telehealth, previous findings suggest that perceived healthcare quality seems to be more closely related to the characteristics of the provider rather than the patient.

Although several existing cross-sectional studies explore experiences with telehealth using samples of chronic disease patients, this study is one of the first to compare experiences across varying chronic disease statuses. The findings of this study can be applied to new telehealth interventions and healthcare providers who treat patients with chronic diseases.

Positive patient perceptions of telehealth are critical to the widespread adoption of telehealth, and improved communication between patients and providers can increase patient satisfaction. Because those with more chronic conditions had more difficulties communicating with healthcare providers, offering communication-based training for both providers and patients with multiple chronic conditions could improve communication. Consistent telehealth visits for the self-management of chronic diseases could also target both issues with communication and unmet health needs, as these interventions have been shown to lead to higher satisfaction and improved patient-provider relationships.

Betia Zeng is an undergraduate student at the Edward J. Bloustein School at Rutgers, The State University of New Jersey.