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

More real-world evidence is needed to understand how telemedicine in primary care affects downstream healthcare use.

To assess the impact of primary care visit modes on prescription orders and follow-up healthcare use.

Retrospective cohort study of adult primary care visits in a large Midwestern healthcare system from January to December 2022. Visits were categorized as in-person, video, or audio-only. Inverse probability of treatment weights (IPTW) was used to balance baseline patient demographic and visit characteristics.

In total, 993,029 patients with 2,195,735 primary care visits.

Prescription orders and healthcare use within 30 days (follow-up primary care visit, emergency department (ED) visit, and hospital visit). Generalized linear mixed models with IPTW were used to assess associations between visit mode and outcomes.

Telemedicine accounted for 3.5% of adult primary care visits (3.0% video and 0.5% audio-only). After adjustment, compared to in-person visits, telemedicine visits were associated with more antibiotic orders (video adjusted odds ratio (aOR) = 1.31, 95%CI = 1.25-1.37; audio-only aOR = 1.22, 95%CI = 1.09-1.37). Audio-only visits were also associated with less prescription orders overall (aOR = 0.80, 95%CI = 0.73-0.87) while no difference was observed between video and in-person visits. Telemedicine visits were also associated with more follow-up primary care visits (video aOR = 1.14, 95%CI = 1.08-1.19; audio-only aOR = 1.41, 95%CI = 1.27-1.56) and hospital visits (video aOR = 1.32, 95%CI = 1.18-1.49; audio-only aOR = 1.59, 95%CI = 1.29-1.96). Audio-only visits were associated with more ED visits (aOR = 1.33, 95%CI = 1.11-1.59) while no difference was observed in video visits.

Telemedicine visits in primary care were associated with more antibiotic orders, follow-up primary care visits, and more hospital visits compared to in-person visits; audio-only visits were also associated with less prescriptions and more ED visits. Differences in outcomes by primary care visits mode may reflect how clinicians and patients differentially use video and audio-only visits.