![]() In addition, prior evidence from direct-to-consumer telemedicine, which is often not integrated with the patient’s regular physician or full electronic health record, suggests potential over-prescribing and differences in physician orders and follow-up visits when primary care is delivered through telemedicine compared with through a typical office visit. Still, it is unclear whether telemedicine visits adequately address the patient’s clinical concern, are more likely to require subsequent follow-up outpatient care, or are more likely to be followed by a serious health event that requires an emergency department visit or hospital stay. 1 Many patients and health care practitioners now recognize that video or telephone telemedicine can offer patients access to a clinician without transportation arrangements, time off from work, or time spent in a waiting-room. Longer-term telemedicine use in primary care, however, may not be driven primarily by social distancing efforts but instead may focus on ways that telemedicine can offer a convenient option for expanding access to health care. The COVID-19 pandemic unexpectedly shifted the US health care system toward a large volume of telemedicine care. Video or telephone visits may be a convenient and efficient way to access primary care and address patient needs. ![]() Adjusted emergency department visits and rates of hospitalizations were not statistically significantly different by primary care index visit type.Ĭonclusions and Relevance In this cohort study of patient self-scheduled primary care telemedicine visits within ongoing patient-physician relationships, prescribing and orders were significantly lower for telemedicine visits than for clinic visits, with slightly higher follow-up office visits for telemedicine but no difference in health events (emergency department visits or hospitalizations). Results This study included 1 131 722 patients (611 821 female mean age, 43 years) with 2 178 440 total appointments (307 888 telemedicine), of which 13.5% were for patients younger than 18 years, 22.2% were for patients 65 years or older, and 54.9% were for female patients. Main Outcomes and Measures Adjusted rates of any medication prescribed or laboratory tests or imaging ordered and rates of follow-up health care utilization (in-person visits, emergency department visits, and hospitalizations) within 7 days after the index visit, stratified by index primary care visit type, were generated using multivariable adjustment for patient, access, and clinical characteristics. Objective To examine whether physician prescribing and orders differ between telemedicine and office visits, whether physicians conducting telemedicine visits are more likely to require in-person follow-up, and whether telemedicine visits are associated with more health events.ĭesign, Setting, and Participants This cohort study included all patients who scheduled primary care appointments through the patient portal of a large integrated health care delivery system newly implementing patient-scheduled video telemedicine visits from January 2016 to May 2018. Importance Telemedicine visits can offer patients convenient access to a clinician, but it is unclear whether treatment differs from that with in-person visits or how often patients require in-person follow-up.
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