Telehealth Primary Care Visits Boost In-Person Follow Up

Of more than 2.3 million primary care visits, 51% used telemedicine (19.5% video and 31.3% telephone).

In-person follow-up visits were a bit higher after telemedicine consultations when compared with in-person primary care visits, but that varied by specific clinical condition, according to a study published today in Annals of Internal Medicine.

The study, compiled by clinicians at Kaiser Permanente in Oakland, CA, and funded primarily by a grant from the Agency for Healthcare Research and Quality, sought to discern how well telemedicine addresses patient needs post-COVID public health emergency. 

The study examined a large, integrated health care delivery system with more than 1,300 primary care providers, between April 2021 and December 2021 (including the COVID-19 pandemic Delta wave). Researchers examined the electronic health records of more than 1.5 million adult patients, of whom 26% age 65 or older, 55% were woman, 22% were Asian, 7.4% were Black, 22% were Hispanic, 46.5% were White, 21.5% lived in less-affluent neighborhoods, and 31.8% had a chronic health condition.

Of more than 2.3 million primary care visits, 51% used telemedicine (19.5% video and 31.3% telephone). Medications were prescribed in 47% of office visits, 38% of video visits, and 34.6% of telephone visits.

After the visit, 1.3% of in-person visits, 6.2% of video visits, and 7.6% of telephone visits had a 7-day return in-person primary care visit; 1.6% of in-person visits, 1.8% of video visits, and 2.1% of telephone visits were followed by an emergency department visit. Differences in follow-up office visits were largest after index office versus telephone visits for acute pain conditions and smallest for mental health.

Treatments administered included medication or antibiotic prescribing and laboratory or imaging ordering. Follow-up visits included in-person visits to the primary care office or emergency department or hospitalization within 7 days.

Outcomes were adjusted for sociodemographic and clinical characteristics overall and stratified by clinical area (abdominal pain, gastrointestinal concerns, back pain, dermatologic concerns, musculoskeletal pain, routine care, hypertension or diabetes, and mental health).

In the study setting, telemedicine is fully integrated with ongoing EHRs and with clinicians, and the study examines an insured population during the late COVID-19 pandemic period. Observational comparison lacks detailed severity or symptom measures. Follow-up was limited to 7 days. Clinical area categorization uses diagnosis code rather than symptom.