Related follow-up after telehealth and workplace visits: examine

Sufferers who made appointments to see their major care medical doctors by video or over the cellphone didn’t search considerably extra follow-up care total than those that had conventional in-person visits, in line with Kaiser Permanente analysis revealed November 16 in JAMA Community Open.

The evaluation examined all 2.2 million major care video, phone, and in-person visits scheduled on-line by Kaiser Permanente members in Northern California between 2016 and mid-2018. Of those, 14% have been for cellphone and video visits. The evaluation discovered all 3 go to varieties had comparable charges of follow-up care, together with emergency division visits and hospitalizations.

The outcomes recommend digital visits usually can tackle a affected person’s concern comparably to conventional in-person medical care, mentioned lead writer Mary Reed, DrPH, a analysis scientist with the Kaiser Permanente Division of Analysis.

“This examine solutions the beforehand open query about whether or not video and cellphone visits are much less environment friendly as a result of the majority of sufferers may need to return to the clinic anyway to resolve their medical problem,” Reed mentioned. “We discovered there’s a small margin of further sufferers who return for an in-person go to after telemedicine however it’s surprisingly small: lower than 2%. That may put to relaxation among the issues about telemedicine’s total effectivity for major care.”

That’s excellent news if the pre-pandemic findings apply to pandemic-era digital care, Reed mentioned, given the large improve in digital visits in 2020. Members of Kaiser Permanente in Northern California have been seeing their medical doctors primarily by video or phone throughout the first yr of the COVID-19 pandemic. Digital visits have continued to represent a significant proportion of medical care in late 2021.

The researchers checked out what occurred to sufferers within the week after major care visits and located little distinction in follow-up care. A couple of quarter (25.4%) of video visits had a follow-up inside 7 days, as did 26% of phone visits and 24.5% of clinic visits—the variations between these follow-up charges throughout go to varieties was modest. There was no important distinction in emergency division visits and hospitalizations.

Researchers additionally in contrast what occurred throughout the go to and located some variations. Treatment was prescribed extra usually within the clinic—60% of visits in contrast with 38.6% by video and 34.7% by phone. Laboratory checks or imaging have been ordered in 59.3% of workplace visits, in contrast with 29.2% of video visits and 27.3% of phone visits.

The variations may very well be associated to sufferers selecting to see their physician in individual when the severity of their medical complaints is increased. “It’s doable that these variations in remedy may be pushed by the kinds or seriousness of issues that sufferers selected for every go to sort, or by the diploma to which physicians might assess the affected person in every go to sort,” Reed mentioned. “We have to discover these particulars additional in future analysis.”

The authors famous that their findings are particular to Kaiser Permanente in Northern California, the place clinicians doing digital visits are the identical clinicians who sufferers go to in individual. Additionally, all clinicians have full entry to affected person digital well being data in Kaiser Permanente’s built-in well being care supply mannequin. Different analysis on direct-to-consumer telemedicine could present totally different outcomes—resembling elevated antibiotic prescribing—by telehealth suppliers who do not need ongoing relationships with sufferers and full entry to their historical past, the authors mentioned. The time interval studied preceded the pandemic and included sufferers who voluntarily sought telemedicine visits.

“In distinction to prior research of direct-to-consumer telemedicine, we didn’t discover proof of over-ordering or over-prescribing amongst sufferers utilizing telemedicine to go to their very own major care medical doctors,” the authors wrote. “Video or phone visits could also be a handy and protected method for sufferers to deal with some major care wants with out producing a considerable variety of follow-up workplace visits or experiencing well being occasions.”

Co-author Emilie Muelly, MD, an inside drugs doctor with The Permanente Medical Group, mentioned the outcomes are encouraging for each sufferers and clinicians. “Video visits provide a handy, time-efficient method for sufferers to be bodily examined by their doctor,” Dr. Muelly mentioned. “In lots of circumstances digital care is ample to information medical prognosis and administration. Kaiser Permanente empowers sufferers to decide on their appointment sort with on-line reserving and our work helps the security of this patient-centered triage method.”

The findings assist digital visits as an possibility for sufferers in an built-in care supply mannequin with out growing emergency division and hospital utilization, mentioned Sameer Awsare, MD, The Permanente Medical Group affiliate govt director. “This examine exhibits that in an built-in, value-based care supply system, telemedicine can function a handy and efficient method to supply personalised, high-quality care,” he mentioned.