Follow-Up Visit Volumes Similar for Telehealth, In-Person Care

Telehealth visits for primary care services did not lead to any significant increases in in-person follow-up visits, hospitalizations, or prescription orders, according to a study by Kaiser Permanente researchers published in JAMA Network Open.

Direct-to-consumer telehealth platforms are on the rise, due to their ability to provide individuals with instant virtual care. However, these visits often take place with a new doctor and are not integrated with the patient’s regular physician and EHR. This can potentially lead to over-prescribing and increased follow-up visit volumes.

To understand if the results differ when the telehealth visits are between patients and their regular primary care physicians, researchers looked at all primary care visits at Kaiser Permanente Northern California between January 2016 and May 2018.

Out of the nearly 2.2 million primary care visits, 1.8 million were in-person and 307,888 were conducted via telehealth. Around 20,000 of the telehealth appointments were video visits, while the remaining were audio-only telephone visits.

In-person visits had higher rates of overall medication prescribing compared to telehealth visits, with 51.9 percent of visits leading to a prescription. Meanwhile, only 38.6 percent of video visits and 34.7 percent of telephone visits had an accompanying prescription.

In-person visits led to more antibiotic prescriptions compared to telehealth visits as well.

Additionally, telehealth visits yielded fewer laboratory test and imaging orders. Less than 30 percent of video and telephone visits required lab tests or imaging, compared with 59.3 percent of in-person office visits that did.

Telehealth visits and in-person visits led to similar rates of in-person follow-up visits, the researchers found. In the seven days after a primary care appointment, there were follow-up office visits for 24.5 percent of office visits, 25.4 percent of video visits, and 26 percent of telephone visits. While the rate of follow-up visits was higher for telehealth compared to in-person, there was a less than 2 percent difference.

Telephone visits had slightly higher rates of subsequent emergency department visits in the following seven days, but there was no statistically significant difference between office visits and video visits. Hospitalization rates for all three visit types were similar and low, with 0.23 percent of in-person and video visits and 0.22 percent of telephone visits leading to hospitalization within seven days.

“This study answers the previously open question about whether video and phone visits are less efficient because the bulk of patients might have to come to the clinic anyway to resolve their clinical issue,” Mary Reed, DrPH, research scientist with the Kaiser Permanente Division of Research and lead author of the study, stated in a press release.

Less than 2 percent of patients returned for an in-person visit after a telehealth appointment, according to Reed.

“Video visits offer a convenient, time-efficient way for patients to be physically examined by their physician,” Emilie Muelly, MD, co-author of the study, stated in the press release. “In many cases, virtual care is adequate to guide clinical diagnosis and management.”

The data highlights results from telehealth and in-person visits that occurred before the COVID-19 pandemic, but the results may help influence the current state of telehealth use as well, especially as virtual primary care becomes increasingly popular.

Recent data also revealed that patients prefer to access telehealth services through their regular doctor as opposed to direct-to-consumer platforms, strengthening the case for virtual care and its effectiveness.

Opponents may argue that in-person follow-up visits after telehealth appointments render telehealth ineffective. The Kaiser Permanente study results show that only a small number of telehealth visits required subsequent in-person visits, speaking to telehealth’s potential to deliver quality care.

Patients have even used telehealth to complete necessary follow-up visits. For example, a recent study revealed that patients had high rates of telehealth use for follow-up visits after hospital discharges. Post-discharge visit volumes remained similar to pre-pandemic levels, indicating patients used telehealth in place of in-person follow-up care.