Most telehealth appointments at clinics that serve lower-income California residents were audio-only visits during the early months of the coronavirus pandemic, according to a study released Tuesday by the RAND Corp.

“Lower-income patients may face unique barriers to accessing video visits, while federally qualified health centers may lack resources to develop the necessary infrastructure to conduct video telehealth,” said Lori Uscher-Price, the study’s lead author and a senior policy researcher at the Santa Monica-based nonprofit research organization.

“These are important considerations for policymakers if telehealth continues to be widely embraced in the future.”

The study of more than 500 clinic locations across California found that just under half of primary care medical visits between March and August 2020 were done in person and that 48.5% of appointments occurred via phone and that the remaining 3.4% of appointments occurred via video, researchers said.

The number of behavioral health appointments that occurred via the phone was even higher — 63.3% — with 13.9% being handled via video and 22.8% in person, according to the study.

For behavioral health, 63.3% occurred via telephone, 13.9% occurred via video and 22.8% were in person.

Uscher-Price said there are “important concerns about the quality of audio-only visits,” while noting that eliminating coverage for telephone visits could disproportionately affect under-served populations and threaten the ability of clinics to meet patients’ needs.

Federal officials agreed to reimburse federally qualified health centers to provide both video and audio-only telehealth services to their patients as a result of the coronavirus pandemic, researchers said, noting that there was minimal telehealth use before then.

The study’s findings are published in the Journal of the American Medical Association.

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