A Mixed-Methods Assessment of Coronavirus Disease of 2019–Era Telehealth Acute Care Visits in the Medical Home

Abstract

To compare acute care virtual visits with in-person visits with respect to equity of access, markers of quality and safety, and parent and provider experience, before and during the coronavirus disease 2019 pandemic. We compared patient demographics, antimicrobial prescribing rates, emergency department (ED) use, and patient-experience scores for virtual visits and in-person care at 2 academic pediatric primary care practices using χ2 testing and interrupted time series analyses. Parent and provider focus groups explored themes related to virtual visit experience and acceptability. We compared virtual acute care visits conducted in March 2020-February 2021 (n=8868) with in-person acute care visits conducted in February 2019-March 2020 (n=24 120) and March 2020-February 2021 (n=6054). There were small differences in patient race/ethnicity across the different cohorts (P<.01). Virtual visits were associated with a 9.6% (-11.5%, -7.8%, P<.001) decrease in all antibiotic prescribing and a 13.2% (-22.1%, -4.4%, P<.01) decrease in antibiotic prescribing for acute respiratory tract infections. Unanticipated visits to the ED did not significantly differ among visit types. Patient experience scores were significantly greater (P<.05) for virtual acute care in overall rating of care and likelihood to recommend. Focus group themes included safety, distractibility, convenience, treatment, and technology. Providers were broadly accepting of virtual care while parental views were more mixed. Telehealth acute care visits may not have negative effects on quality and safety, as measured by antimicrobial prescribing and unanticipated ED visit rates. Efforts to increase parental acceptance and avoid creating disparities in access to virtual care will be essential to continued success of telehealth acute care visits.