Patient-Centered Communication in Telehealth Settings

Importance Patient-centered communication (PCC) is key to high-quality health care but remains understudied in telehealth visits. Objectives To examine associations between individual-level characteristics and optimal levels of 7 PCC items and to assess whether these associations differ by county-level vulnerability to public health emergencies per the Minority Health Social Vulnerability Index (MHSVI). Design, Setting, and Participants This was a cross-sectional, online survey of a nonprobability sample of adults, 18 years of age or older, who resided in MHSVI least- or most-vulnerable US counties. Data were collected between February 23 and August 26, 2022, and analyzed between January 10 and May 5, 2025. Exposures Participant characteristics and county-level vulnerability. Main Outcomes and Measures Self-reported optimal levels of 7 PCC items. For each item, multivariable logistic regression models were fit for the overall sample and stratified by MHSVI. Results The survey participation rate was 17.0%. A total of 2754 adults (mean SE age, 43.9 0.3 years) had at least 1 telehealth visit in the past year and resided in 649 of the MHSVI least- or most-vulnerable counties. The sample included 1568 females (56.9%), with 1650 participants (59.9%) self-identifying as White and 1104 participants (40.1%) self-identifying as being in a racial or ethnic minority group (Black or African American, 465 16.9%; Hispanic or Latino, 501 18.2%; and other, 138 5.0%). Optimal PCC ranged from 1069 participants (38.8%) self-reporting that clinicians spent sufficient time with them to 1372 participants (49.8%) reporting that clinicians ensured their understanding. Decreased odds of reporting optimal PCC (eg, clinicians ensuring understanding) were associated with educational attainment (adjusted odds ratio AOR, 0.86 95% CI, 0.77-0.96) and not being proficient in English (AOR, 0.39 95% CI, 0.28-0.53). Increased odds were associated with digital health literacy domains (eg, access to digital services that work AOR, 1.49 95% CI, 1.09-2.04). Hispanic or Latino and Black or African American participants reported optimal PCC that was largely comparable with White participants. Associations between individual-level characteristics and optimal PCC differed by MHSVI. For example, Black or African American participants were less likely to report optimal time spent with clinicians in the MHSVI most-vulnerable counties (AOR, 0.73 95% CI, 0.54-0.98), but more likely to report that clinicians explained things in least-vulnerable counties (AOR, 1.74 95% CI, 1.03-2.94). Educational attainment was associated with lower odds of reporting optimal PCC in the MHSVI most-vulnerable counties only (eg, clinicians ensured understanding AOR, 0.85 95% CI, 0.74-0.98), whereas associations with English nonproficiency (eg, clinicians ensured understanding AOR, 0.40 95% CI, 0.27-0.59 for most vulnerable and 0.35 95% CI, 0.20-0.59 for least vulnerable) and digital health literacy (eg, clinicians gave the opportunity to ask questions for access to digital services that work AOR, 2.29 95% CI, 1.50-3.49 for most vulnerable and 2.09 95% CI, 1.31-3.36 for least vulnerable) were largely consistent across both MHSVI strata. Conclusions and Relevance In this cross-sectional study, optimal PCC was comparable by race and ethnicity but not by educational attainment or English proficiency. Overall, the findings suggest that telehealth may facilitate optimal PCC.