Patients Often Lack Choice Regarding Care Via Telehealth

Psychiatric TimesVol 40, Issue 10

According to research, 32% of patients said they did not typically receive care via their preferred method, and nearly half (45%) did not think their clinician considered their preferences when deciding on the visit type.



The growing use of telehealth following the COVID-19 pandemic was expected to give patients flexibility and the choice to obtain care in person or remotely. Researchers in a new study, however, discovered that telehealth is the only option for approximately one-third of patients seeking behavioral health services, even when they prefer in-person treatment.1

In a nationally representative study of 2071 adults in the US, researchers from RAND Corporation and Harvard University identified and interviewed 571 adults who used behavioral health services during the prior year, including 26 who had been treated for bipolar disorder or depression during February and March 2023.1 Patients were asked if they thought they had a choice of methods for conducting visits for medication and therapy services, and how the decision to use a particular method was made.

Approximately one-third of patients receiving medication or therapy saw clinicians who did not offer both telehealth and in-person care, 9% reported their clinicians only offered in-person care, and 22% said their clinicians only offered telepsychiatry. More importantly, 32% said they did not typically receive care via their preferred method, and nearly half (45%) did not think their clinician considered their preferences when deciding on the visit type.

According to the study results, approximately 80% of participants received individual behavioral therapy in the prior year via telehealth visits, compared with only 42% with in-person visits. Meanwhile, many patients noted they preferred in-person therapy visits because it was more personal and enabled them to establish a better rapport with their clinician.

Slightly more patients (58%) with medication visits received care in person compared with those who had medication visits virtually (54%). Regardless of their preference, however, a majority said they wanted clinicians to offer both options.

“These findings suggest that patients’ modality preferences need to be a greater consideration in both clinical discussions and policy decisions,” Jessica Sousa, MSW, MPH, the study’s lead author and a RAND senior policy analyst, said in a news release.2 “Expanding telehealth increases access to care, but telehealth alone might not be sufficient. Ideally, patients should have access to some amount of in-person care, given that many prefer it or may need it.”

At the start of the COVID-19 pandemic, many payers began reimbursing for telehealth services so clinicians could continue providing care, leading some behavioral health providers to offer only telehealth visits because of the lifestyle and productivity advantages.

“Although generous payment policies may encourage clinicians to offer telehealth, they may also inadvertently lead to cannibalization of in-person care,” Sousa added.2 “For telehealth to achieve its potential to increase overall access to high-quality, patient-centered care, it is important to implement it in a manner that expands, rather than contracts, behavioral health access and options for patients.”



1. Sousa J, Smith A, Richard J, et al. Choosing or losing in behavioral health: a study of patients’ experiences selecting telehealth versus in-person care. Health Aff (Millwood). 2023;42(9):1275-1282.

2. Many patients don’t get to choose the type of behavioral health visit they receive. News release. RAND Corporation. September 5, 2023. Accessed September 8, 2023.

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