Impact of Visit Modality on Utilization and Outcomes in Primary Care: Initial Assessments of Low Back Pain

Little is known about how the modality of an initial primary care visit affects downstream health care utilization and resource use. Low back pain is an ideal condition to examine this question given its high prevalence and well-characterized natural history. This study assessed how the first appointment visit type (telephone visit, video visit, or office appointment) affected follow-up appointments and imaging utilization among adults seeking a first-time evaluation for low back pain.

This retrospective cohort study included adult Kaiser Permanente Northern California members who were treated for a new instance of low back pain between April 1, 2021, and September 30, 2022. Of 208,356 eligible adults, 62,881 met inclusion criteria. The exposure was index visit type; outcomes included follow-up and emergency department visits within 8 weeks and imaging ordered within 8 weeks of diagnosis.

Index visits were conducted in-office (n = 25,712), by telephone (n = 24,191), and by video (n = 12,978). Telephone index visits had the highest proportion with at least one follow-up visit (14.6%) compared with video (10.8%) and in-office (7.6%) visits (P < .001). After covariate adjustment, the incidence of follow-up visits was nearly twice as high for telephone compared with in-office visits (adjusted incidence rate ratio [aIRR], 1.99; 95% confidence interval [CI], 1.88-2.11) and 47% higher for video visits than for in-office visits (aIRR, 1.47; 95% CI, 1.36-1.58).

Initial telemedicine evaluation of low back pain by telephone was associated with higher rates of downstream follow-up and emergency department visits compared with in-office care, while being associated with lower imaging utilization.