Abstract
Telemedicine visits can offer patients convenient access to a clinician, but it is unclear whether treatment differs from that with in-person visits or how often patients require in-person follow-up. To examine whether physician prescribing and orders differ between telemedicine and office visits, whether physicians conducting telemedicine visits are more likely to require in-person follow-up, and whether telemedicine visits are associated with more health events. This cohort study included all patients who scheduled primary care appointments through the patient portal of a large integrated health care delivery system newly implementing patient-scheduled video telemedicine visits from January 2016 to May 2018. Adjusted rates of any medication prescribed or laboratory tests or imaging ordered and rates of follow-up health care utilization (in-person visits, emergency department visits, and hospitalizations) within 7 days after the index visit, stratified by index primary care visit type, were generated using multivariable adjustment for patient, access, and clinical characteristics. This study included 1 131 722 patients (611 821 [54%] female; mean [SD] age, 43 [22] years) with 2 178 440 total appointments (307 888 [14%] telemedicine), of which 13.5% were for patients younger than 18 years, 22.2% were for patients 65 years or older, and 54.9% were for female patients. After adjustment, 38.6% (95% CI, 38.0%-39.3%) of video visits, 34.7% (95% CI, 34.5%-34.9%) of telephone visits, and 51.9% (95% CI, 51.8%-52.0%) of office visits had any medication prescribed; laboratory tests or imaging were ordered for 29.2% (95% CI, 28.5%-29.8%) of video visits, 27.3% (95% CI, 27.1%-27.5%) of telephone visits, and 59.3% (95% CI, 59.3%-59.4%) of clinic visits. After adjustment, follow-up visits within 7 days occurred after 25.4% (95% CI, 24.7%-26.0%) of video visits, 26.0% (95% CI, 25.9%-26.2%) of telephone visits, and 24.5% (95% CI, 24.5%-24.6%) of office visits. Adjusted emergency department visits and rates of hospitalizations were not statistically significantly different by primary care index visit type. In this cohort study of patient self-scheduled primary care telemedicine visits within ongoing patient-physician relationships, prescribing and orders were significantly lower for telemedicine visits than for clinic visits, with slightly higher follow-up office visits for telemedicine but no difference in health events (emergency department visits or hospitalizations). Video or telephone visits may be a convenient and efficient way to access primary care and address patient needs.
Highlights
The COVID-19 pandemic unexpectedly shifted the US health care system toward a large volume of telemedicine care
38.6% of video visits, 34.7% of telephone visits, and 51.9% of office visits had any medication prescribed; laboratory tests or imaging were ordered for 29.2% of video visits, 27.3% of telephone visits, and 59.3% of clinic visits
Follow-up visits within 7 days occurred after 25.4% of video visits, 26.0% of telephone visits, and 24.5% of office visits
Summary
The COVID-19 pandemic unexpectedly shifted the US health care system toward a large volume of telemedicine care. Longer-term telemedicine use in primary care, may not be driven primarily by social distancing efforts but instead may focus on ways that telemedicine can offer a convenient option for expanding access to health care.[1] Many patients and health care practitioners recognize that video or telephone telemedicine can offer patients access to a clinician without transportation arrangements, time off from work, or time spent in a waiting-room Still, it is unclear whether telemedicine visits adequately address the patient’s clinical concern, are more likely to require subsequent follow-up outpatient care, or are more likely to be followed by a serious health event that requires an emergency department visit or hospital stay. Prior evidence from direct-to-consumer telemedicine, which is often not integrated with the patient’s regular physician or full electronic health record, suggests potential overprescribing and differences in physician orders and follow-up visits when primary care is delivered through telemedicine compared with through a typical office visit.[2,3,4] In contrast, little evidence exists about these care processes in telemedicine visits between patients and their own primary care physicians.[5]
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