Introduction Telemedicine is increasingly relied upon for care delivery in primary care, but the impact of visit type on clinical ordering behavior is uncertain. Methods Within Kaiser Permanente Northern California, we identified patients who self-scheduled and completed telemedicine encounters with their personal primary care provider or another available primary care provider in the same medical group, between April 1st, 2020, and October 31st, 2020, while physical distancing restrictions for COVID-19 were in place. We collected patient sociodemographic and clinical characteristics, measures of technology access, and categorized the most common primary encounter diagnoses. We measured proportions of patient-scheduled video versus telephone visits for each of eight diagnosis groups (Skin & Soft Tissue, Musculoskeletal Pain, Back Pain, General Gastrointestinal, Hypertension & Diabetes, Mental Health, Upper Respiratory, and Abdominal Pain), and compared physician orders for medications, antibiotics, lab and imaging studies by visit type within each diagnosis group. Results There were 273,301 included encounters, with 86,676 (41.5%) video visits and 122,051 (58.5%) telephone visits. Of the diagnosis groups, Skin & Soft Tissue conditions had the highest proportion of video visits (59.7%), while Mental Health conditions had the highest proportion of telephone visits (71.1%). After adjusting for covariates, the overall rates of medication orders (46.6% vs. 44.5%), imaging orders (17.3% vs. 14.9%), lab orders (19.5% vs. 17.2%), and antibiotic orders (7.5% vs. 5.2%) were higher during video visits as compared to telephone visits (p < 0.05). The largest difference within diagnosis groups was for Skin & Soft Tissue conditions, where the rate of medication orders was 9.1% higher than during video visits than telephone visits (45.5% vs. 36.5%, p < 0.05). Conclusions We observed statistically significant differences in clinician orders by visit type during telemedicine encounters for common primary care conditions. Our findings suggest that, for certain conditions, visual information conveyed during video visits may promote clinical work-up and treatment.
This study was conducted within Kaiser Permanente Northern California (KPNC) and approved by the KPNC Institutional Review Board. Conflict of Interest: The following conflicts of interest are reported: Joan Lo has received research funding from Amgen, Inc., and Sanofi Aventis and Malini Chandra has received research funding from Amgen, not pertaining to this study; Bruce Ettinger has served as an expert witness pertaining to litigation involving teriparatide (Teva Pharmaceuticals). The remaining authors have no conflicts of interest to disclose.
Background Patient understanding of their care, supported by physician involvement and consistent communication, is key to positive health outcomes. However, patient and care team characteristics can hinder this understanding. Objective We aimed to assess inpatients’ understanding of their care and their perceived receipt of mixed messages, as well as the associated patient, care team, and hospitalization characteristics. Design We administered a 30-item survey to inpatients between February 2020 and November 2021 and incorporated other hospitalization data from patients’ health records. Participants Randomly selected inpatients at two urban academic hospitals in the USA who were (1) admitted to general medicine services and (2) on or past the third day of their hospitalization. Main Measures Outcome measures include (1) knowledge of main doctor and (2) frequency of mixed messages. Potential predictors included mean notes per day, number of consultants involved in the patient’s care, number of unit transfers, number of attending physicians, length of stay, age, sex, insurance type, and primary race. Key Results A total of 172 patients participated in our survey. Most patients were unaware of their main doctor, an issue related to more daily interactions with care team members. Twenty-three percent of patients reported receiving mixed messages at least sometimes, most often between doctors on the primary team and consulting doctors. However, the likelihood of receiving mixed messages decreased with more daily interactions with care team members. Conclusions Patients were often unaware of their main doctor, and almost a quarter perceived receiving mixed messages about their care. Future research should examine patients’ understanding of different aspects of their care, and the nature of interactions that might improve clarity around who’s in charge while simultaneously reducing the receipt of mixed messages. Supplementary Information The online version contains supplementary material available at 10.1007/s11606-023-08178-4.
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