Virtual Obstetric, Fertility Care Likely to Prompt In-Person Follow-ups

Most patients participating in a virtual visit for obstetric and fertility care required an in-person follow-up visit in the three months after their telehealth visit, new research shows.

Conducted by Epic Research, the study includes an analysis of 35 million telehealth visits conducted between March 1, 2020, and May 31, 2022. The researchers' goal was to determine the overall rates of telehealth visits by specialty and identify how often these visits required in-person follow-up within the same specialty.

The study utilized data from Cosmos, a HIPAA-defined dataset of more than 170 million patients from 180 organizations that use the Epic EHR, including 1,063 hospitals and more than 22,500 clinics.

Researchers found that in nearly every specialty studied, most telehealth patients did not require an in-person follow-up appointment in that specialty in the three months following the virtual visit.

The specialties with the lowest rates of in-person follow-up appointments were genetics, nutrition, and endocrinology, with only 4 percent, 10 percent, and 14 percent of patients needing an in-person follow-up within these specialties.

Mental health and psychiatry had the largest telehealth usage rates of all the specialties studied but among the lowest rates of patients requiring in-person follow-up. Only 15 percent of patients needed an in-person follow-up within three months among the 4.3 million patients who participated in a virtual visit for mental health and psychiatry services.

On the other end of the spectrum is obstetrics, with 92 percent of patients needing an in-person visit three months after a telehealth appointment. Similarly, virtual fertility and geriatric care resulted in 54 percent and 50 percent of patients requiring an in-person follow-up, respectively. Additionally, 43 percent of surgery patients needed in-person care in the three months following a telehealth visit.

"…high follow-up rates were present only in specialties that unavoidably require regular visits with an in-person component for hands-on care, such as obstetrics and surgery," the report notes.

According to the researchers, the study findings show that as long as telehealth is not duplicating in-person care, it is an efficient use of resources and unlikely to result in follow-up care for many specialties. Thus, they concluded that it is an effective tool for expanding access to care.

These study results add to existing research on the link between telehealth and follow-up care.

A study published last November showed that telehealth visits for primary care services did not significantly increase in-person follow-up visits.

For the study, researchers examined 2.2 million primary care visits at Kaiser Permanente Northern California, between January 2016 and May 2018. Of these, 1.8 million were in-person visits, and 307,888 were conducted via telehealth.

The researchers found that the rates of in-person follow-up visits were similar for telehealth and in-person appointments. In the week following a primary care appointment, 24.5 percent of office visits, 25.4 percent of video visits, and 26 percent of telephone visits resulted in follow-up office visits.

But conflicting research reveals a gap between follow-up care after a telehealth appointment and an in-person office visit.

According to a study published in April, telehealth appointments for acute conditions were more likely to result in follow-up visits than in-person appointments. Published in JAMA Network Open, the study analyzed follow-up activity 14 days after virtual or in-person care encounters for 40 million patients.

But the study also found that initial telehealth visits for chronic conditions resulted in similar follow-up rates as initial in-person encounters for these conditions.