How does virtual primary care affect pediatric care utilization?

New research shows that virtual primary care for pediatric patients is associated with less prescribing and ordering than in-person visits; however, telehealth visits resulted in slightly higher rates of subsequent in-person and emergency department visits.

Published in JAMA Health Forum, the study highlighted the impact of telehealth visits on downstream healthcare utilization within pediatric primary care. Virtual primary care has grown popular in recent years. While some research shows that virtual primary care has not increased downstream healthcare utilization, the study authors from Kaiser Permanente wrote that these results need to be confirmed in a larger population.

Thus, they conducted the cohort study at Kaiser Permanente North California to compare healthcare utilization stemming from pediatric primary care visits conducted in person and via telehealth. The researchers studied all completed primary care pediatric appointments from Jan. 1, 2022, through Dec. 31, 2022. They gathered data on medication prescribing, laboratory orders and imaging orders, among other metrics, associated with each visit.

The study included 782,596 primary care visits scheduled by 438,638 patients. Of these, 450,443 (57.6%) were in-person office visits and 332,153 (42.4%) were telehealth visits. Telehealth visits were provided through synchronous video (18.4%) and audio-only modalities (24%).

Researchers found that medication prescribing and lab ordering rates were higher for in-person visits than for telehealth visits. While the medication prescribing rate was 39.8% for in-person visits, the rate was 29.5% for video visits and 27.3% for audio-only visits. Additionally, antibiotic prescribing rates associated with video visits (12.1%) and audio-only visits (10.1%) were lower than those for in-person visits (17.8%).

Similarly, lab ordering rates were 24.6% for in-person appointments versus 7.8% for video and 8.5% for audio-only visits. Imaging ordering was also higher for in-person visits (8.5%) compared with video visits (4%) and audio-only visits (3.5%).

However, the study shows in-person follow-up care was higher following telehealth visits. Only 4.3% of in-person visits led to an in-person follow-up visit, whereas 14.4% of video and 15.1% of audio-only visits prompted in-person follow-ups.

Notably, most in-person follow-ups following a telehealth visit occurred within the first 24 hours of the initial visit, while most in-person follow-ups after an in-person visit occurred more than 24 hours after the initial visit.

"This finding appears to support a role for telemedicine in identifying patients who need prompt in-person evaluation to meet their care needs," the researchers noted.

Further, while there were fewer ED visits following in-person visits (1.75%) compared with video visits (2.04%) and audio-only visits (2%), hospitalization rates across the three groups were similar.

"The lack of significant difference in downstream hospitalization suggests that patients who initially made telemedicine visits did not have worse outcomes than those who initially made in-person visits, even if some needed to return for in-person follow-up visits," the researchers wrote.

Thus, they concluded that telehealth is effective as a care delivery mechanism for pediatric patients, "although it is not a universal substitute for in-person visits."

The study comes as scrutiny around the quality of virtual care grows. According to market experts, determining the value of virtual care will be critical to care delivery strategies moving forward.

While some research shows that virtual care quality is on par with in-person care quality, other studies question the evidence itself.

Research published in June 2024 assessed 77 studies from March 2020 to April 2023. Though the researchers found that the differences between telehealth and in-person care with regard to healthcare utilization and clinical outcomes were generally small and not clinically meaningful, they also noted that the available evidence is "weak and heterogeneous."

Anuja Vaidya has covered the healthcare industry since 2012. She currently covers the virtual healthcare landscape, including telehealth, remote patient monitoring and digital therapeutics.