Patient outcomes point to efficacy of telehealth and virtual care

By Nathan Eddy

The emergence of telehealth during the COVID-19 pandemic and the resulting surge in the adoption of telemedicine are helping address patients’ needs without major signs of safety concerns, according to a study by Kaiser Permanente.

WHY IT MATTERS

The study, published in the Annals of Internal Medicine, analyzed more than 1.5 million adult patients at Kaiser Permanente Northern California in 2021, and compared treatment and follow-up visits among primary care telemedicine (video and telephone) and in-person office visits.

Of the 2,357,598 primary care visits analyzed, just over half (50.8%) utilized telemedicine, which broke down to just under 20% composed of video visits and 31.3% telephone visits.

The findings indicate that medication prescriptions were lower for video and telephone visits at 38.4% and 34.6%, respectively, compared to in-person visits at 46.8%. Additionally, follow-up appointments within seven days were less frequent for in-person visits (1.3%) compared to video (6.2%) and telephone (7.6%) visits.

Treatment outcomes included prescription of medications or antibiotics and the ordering of laboratory or imaging tests.

Follow-up visits were categorized as in-person visits to the primary care office, visits to the emergency department, or hospitalizations within seven days.

The research adjusted outcomes for sociodemographic and clinical characteristics, both overall and when stratified by clinical area.

Limitations of the study include the observational nature of the comparison, which the report noted lacks detailed symptom measures and the focus on follow-up within a seven-day window.

The study concluded that post-pandemic telemedicine is likely to remain a convenient primary care option for patients, particularly those facing barriers to in-person visits.

THE LARGER TREND

This week, HIMSS, parent company of Healthcare IT News, is recognizing its annual Global Health Equity Week, and virtual care has long been recognized as a key enabler toward improving access to care and wider health equity for underserved publications.

Telehealth and remote patient monitoring could help address many key chronic care management challenges at a time where rising healthcare costs and staff shortages are straining the nation’s healthcare system.

Virtual care can help ease the rural mental health crisis, while teleneurology is improving access and care for veterans.

Telehealth has also proven successful for opioid use disorder treatment, with virtual care provider Ophelia finding 56% of its OUD patients remained in treatment for six months and 48% stayed for one year, with retention rates significantly higher than traditional in-person care.

In September, the American Telemedicine Association released a SDOH tool kit to scale community telehealth delivery.

The new measures, calculators and other tools will help communities address the economic burden of inaction on health disparities and improve health through better access to virtual care.

Despite the promise of telemedicine, older Americans are facing some barriers to adoption, including struggles with digital channels, access and ease of use.

ON THE RECORD

“As patients and health systems have expanded longer term use of telemedicine to broader clinical use cases, even after the initial COVID-19 pandemic emergency, we found ongoing telemedicine use is fairly effective in having limited return office visits, low emergency visit rates, and very low hospitalization rates compared to office visits,” explained Dr. Mary Reed, research scientist, Kaiser Permanente Northern California Division of Research

She added that she thinks this should be seen as evidence of the success of telemedicine across the broad clinical use cases in primary care.

“It’s worth mentioning also that the telemedicine setting we studied is an integrated system where patients see their own providers via telemedicine, the same clinicians they would see if they came to a clinic visit,” said Reed. “This consistency may be one reason why we did not see high rates of follow-up in office visits or emergency departments after virtual care.”

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