This study helps to build understanding about the quality of care, potential benefits, and the future role of telemedicine in primary care settings.
Study Overview
Problem: More patients are using telemedicine visits for primary care, which reduces barriers to care such as transportation, childcare, and the need to take time off from work. However, before the COVID-19 pandemic there had been little research comparing the quality and effectiveness of telemedicine to in-person visits.
Main Objective: To understand which patient characteristics are associated with telemedicine utilization, and to understand how telemedicine compares in quality, care processes, and patient outcomes to in-person care.
Approach: To collect information about technology usability, convenience, and patient-reported outcomes for telemedicine visits in primary care, the research team conducted surveys with patients (700 pre-pandemic and 1,000 post pandemic) and interviews with clinicians and organizational leaders. The research team is also using electronic health record data in northern California from the multi-year study period to examine rates of prescribing and ordering, follow-up visits, and emergency department visits following telemedicine preventative care visits compared to in-person visits.
Results: Prior to the COVID-19 pandemic, the research team found that patients who were female, under 40, and had access to high-speed internet selected telemedicine visits more often.1 In addition, Black patients were more likely than patients of other races to choose to have a telemedicine visit.1 Researchers also found that there were lower rates of prescribing and higher rates of follow-up office visits for patients with telemedicine visits compared to patients with in-person visits, but there were no significant differences in emergency visits or hospitalizations.2
During the pandemic, the research team found that Black and Hispanic patients, patients living in neighborhoods with lower internet access, and patients living in neighborhoods with lower socioeconomic status were more likely to schedule telephone visits than video visits.3 Patients more likely to schedule video visits included people 65 or older, those with prior experience having video visits, and those visiting their usual primary care provider.3 Rates of medication prescriptions and laboratory/ imaging orders were higher for patients with video visits compared to patients with telephone visits.
Rates of follow-up office visits, emergency department visits, and hospitalizations were lower following video visits compared to telephone visits, but these outcomes were rare across all telemedicine visits.4
Publications from this study can be found here.
Primary Care Relevance
Findings from this study demonstrate that while there are some differences in primary care treatment via telemedicine compared with in-person care, negative outcomes were rare. Use of telemedicine shifted dramatically during the COVID-19 pandemic, with some gaps in equitable use of video telemedicine.
AHRQ Primary Care Priority Area
Research to improve primary care, including regarding quality, access and affordability, the workforce, care delivery models, financing, digital healthcare, person-centeredness, and health equity.
Notes
1. Reed ME, Huang J, Graetz I, Lee C, Muelly E, Kennedy C, Kim E. Patient Characteristics Associated With Choosing a Telemedicine Visit vs Office Visit With the Same Primary Care Clinicians. JAMA Netw Open 2020 Jun 1;3(6):e205873. doi: 10.1001/jamanetworkopen.2020.5873. PMID: 32585018; PMCID: PMC7301227.
2. Reed M, Huang J, Graetz I, Muelly E, Millman A, Lee C. Treatment and Follow-up Care Associated With Patient-Scheduled Primary Care Telemedicine and In-Person Visits in a Large Integrated Health System. JAMA Netw Open 2021 Nov 1;4(11): e2132793. doi: 10.1001/jamanetworkopen.2021.32793. PMID: 34783828; PMCID: PMC8596201.
3. Huang J, Graetz I, Millman A, Gopalan A, Lee C, Muelly E, Reed ME. Primary care telemedicine during the COVID-19 pandemic: patient's choice of video versus telephone visit. JAMIA Open 2022 Jan 19;5(1):ooac002. doi: 10.1093/jamiaopen/ooac002. PMID: 35146380; PMCID: PMC8822408.
4. Huang J, Gopalan A, Muelly E, Hsueh L, Millman A, Graetz I, Reed M. Primary care video and telephone telemedicine during the COVID-19 pandemic: treatment and follow-up health care utilization. Am J Manag Care 2023 Jan 1;29(1):e13-e17. doi: 10.37765/ajmc.2023.89307. PMID: 36716159.
