Analysis and Observations of Telehealth in Primary Care Follow Up Appointments for Vulnerable Populations

The Milwaukee Health Care Partnership's Emergency Department Care Coordination (EDCC) initiative allows vulnerable patients in 8 local emergency departments to schedule a follow-up primary care appointment upon discharge at primary care safety net clinics. In March 2020, EDCC receiving clinics transitioned all appointments to telehealth due to the COVID-19 pandemic. The objectives of this study were to examine the effect of telehealth on the show rate at EDCC initial follow-up appointments and obtain perspectives on the strengths and weaknesses of primary care via telehealth through statistical analysis of appointments and patient and provider feedback.

EDCC data were analyzed for appointments scheduled from 2018 through 2021. Using univariate logistic regression, the show rate was examined before and after the adoption of telehealth. In addition, surveys of EDCC patients were conducted after telehealth visits, and feedback was solicited from receiving clinic providers.

Nearly 3900 (n=3897) primary care visits were scheduled through EDCC within the date range; 284 were conducted via telehealth. After controlling for age, sex, insurance, clinic location, and lead time, telehealth appointments were associated with a lower no-show rate than in-person appointments (P=0.002). Qualitative studies revealed that telehealth can help patients overcome barriers, specifically transportation and childcare concerns, but is difficult for older and non-English speaking patients.

Patients were significantly more likely to attend follow-up visits conducted via telehealth. Patients and clinicians identified telehealth as a means of overcoming socioeconomic barriers but also cited drawbacks to its use. Further research is needed to identify the ongoing role of telehealth and specific populations that would benefit most from its potential.