Downstream Healthcare Use Associated with Primary Care In-Person and Telemedicine Visits in 2022

Area of Science:

• Healthcare Delivery
• Primary Care Medicine
• Digital Health

Background:

• Real-world evidence on telemedicine's impact on primary care downstream healthcare utilization is limited.
• Understanding how different primary care visit modalities influence patient outcomes is crucial.

Purpose of the Study:

• To evaluate the effect of primary care visit modes (in-person, video, audio-only) on prescription patterns and subsequent healthcare use.
• To compare outcomes associated with telemedicine versus in-person primary care visits.

Main Methods:

• Retrospective cohort study analyzing over 2 million primary care visits from a Midwestern healthcare system (2022).
• Visits categorized into in-person, video, or audio-only telemedicine.
• Inverse probability of treatment weighting (IPTW) used to adjust for patient and visit characteristics.
• Generalized linear mixed models assessed associations between visit mode and outcomes within 30 days (prescriptions, follow-up visits, ED visits, hospitalizations).

Main Results:

• Telemedicine constituted 3.5% of visits (3.0% video, 0.5% audio-only).
• Telemedicine visits showed increased antibiotic orders compared to in-person visits.
• Audio-only visits were linked to fewer overall prescriptions but more emergency department visits.
• Both video and audio-only telemedicine visits were associated with higher rates of follow-up primary care and hospital visits.

Conclusions:

• Primary care telemedicine, particularly audio-only, is associated with increased antibiotic prescribing and hospital use.
• Differences in outcomes suggest varying clinical utility and patient-provider interaction patterns across telemedicine modalities.
• Further research is needed to optimize telemedicine integration into primary care to ensure equitable and effective healthcare delivery.