Telehealth With Own Physician Less Likely to Result in ED Visits

Virtual visits with physicians with whom patients did not have an ongoing relationship increased the likelihood of patients going to the emergency department (ED) by 66 percent, according to a recent study.

Amid the rapid growth in telehealth use during the COVID-19 pandemic, concerns grew around the continuity of care. Direct-to-consumer telehealth can help improve access to healthcare; however, it can also lead to fragmentation of care since the patient may not have an ongoing relationship with the physician providing the on-demand service.

The study published in JAMA Network Open aimed to assess the difference in ED use following a virtual visit with a patient’s own family physician and one with an outside physician. It uses data from residents in Ontario, Canada, who had a virtual visit with a family physician from April 1, 2021, to March 31, 2022. The primary outcome was whether an ED visit occurred within seven days of the virtual visit.

Researchers assessed data for 5.22 million individuals in Ontario, of which 4.17 million had their initial virtual visit with their own physician and 1.05 million patients had their visit with an outside physician. Patients participating in virtual visits with outside physicians were younger, more likely to live in a large urban area, and made fewer visits to their own physicians in the prior two years compared with patients who had telehealth visits with their own physicians.

The researchers found that patients who had virtual visits with an outside physician were 66 percent more likely to visit an ED within seven days, corresponding to one additional ED visit for every 77 virtual visits with an outside physician.

Additionally, the researchers found that the increased ED use associated with virtual visits with outside physicians “was front-loaded in the first few days, suggesting that virtual visits may serve a triaging function, allowing for the identification of patients who would benefit from an in-person assessment.”

Patients participating in virtual visits with outside physicians were also more likely than those meeting with their own physician to have an in-person family physician visit within seven days. But they were less likely to have such a visit with their own physician. This suggests that “these visits may have been repeat visits to walk-in clinics or virtual walk-in clinics,” researchers stated.

Thus, the study findings “support the use of primary care virtual visits within an existing clinician-patient relationship,” the researchers concluded.

Research on telehealth and its impact on healthcare utilization is growing.

For instance, a study published last October showed that the rate of in-person follow-up visits was low overall following phone and video visits for primary care but still higher than after in-person appointments.

Conducted by the Kaiser Permanente Division of Research, the study included administrative and EHR data for 1.5 million adult patients receiving primary care between April 2021 and December 2021. Of 2.3 million primary care visits, 50.8 percent occurred via telehealth, with 19.5 percent via video and 31.3 percent via the telephone.

The researchers found that 6.2 percent of video visits and 7.6 percent of telephone visits resulted in an in-person follow-up visit within seven days. While these rates are low, they are higher than the seven-day in-person follow-up rate for in-person visits at 1.3 percent.

Another study published in November revealed that the likelihood of patients completing recommended tests and seeking specialty referrals is worse when ordered during telehealth visits than in-person appointments.

Researchers examined visits from March 1, 2020, to December 31, 2021, gathering data for three types of high-risk tests and referrals ordered in that period: colonoscopy screenings and diagnostic referrals, dermatology referrals for suspicious skin lesions, and cardiac stress tests, including exercise and chemical stress tests, with and without imaging.

Between March 1, 2020, and March 30, 2022, only 42.6 percent of tests and referrals ordered during telehealth visits were completed, versus 58.4 percent of orders placed during an in-person visit and 57.4 percent placed without a visit.