Changes in Virtual and In-Person Health Care Utilization in a Large Health System During the COVID-19 Pandemic

Zachrison, Kori S; Yan, Zhiyu; Schwamm, Lee H

doi:10.1001/jamanetworkopen.2021.29973

Cited by 33 publications

(38 citation statements)

References 3 publications

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“…This suggests that availability of telehealth visits in primary care may be associated with increased individual primary care utilization. Our findings contrast with those of prior studies that included primary care during a contemporary period which showed no increase in utilization [6][7][8], though our study differs in methodology and population demographics. We uniquely focus on utilization in primary care only whereas prior literature that included primary care [6][7][8] aggregated outpatient specialties together.…”

Section: Plos Onecontrasting

confidence: 99%

“…Our findings contrast with those of prior studies that included primary care during a contemporary period which showed no increase in utilization [6][7][8], though our study differs in methodology and population demographics. We uniquely focus on utilization in primary care only whereas prior literature that included primary care [6][7][8] aggregated outpatient specialties together. The impact of telehealth on different service lines may be different; for example, compared with historical averages, behavioral health services may have experienced rapid adoption and increased total visit volumes with telehealth during the pandemic [6], whereas surgical specialties may have had slower adoption and depressed visit volumes despite telehealth availability during the pandemic [9].…”

Section: Plos Onecontrasting

confidence: 99%

“…We also chose not to use a historical comparison for visit volume since total visit volumes during the study period were affected by the pandemic. Another difference is in patient demographics; for example, in prior studies that included primary care, 30-77% of patients were White, 8-40% Hispanic, 6-8% Black, and 4-10% Asian [6][7][8]. In contrast, 9% of our patients were White, 34% Black, 34% Hispanic, and 7% Asian.…”

Section: Plos Onementioning

confidence: 76%

“…We uniquely focus on utilization in primary care only whereas prior literature that included primary care [6][7][8] aggregated outpatient specialties together. The impact of telehealth on different service lines may be different; for example, compared with historical averages, behavioral health services may have experienced rapid adoption and increased total visit volumes with telehealth during the pandemic [6], whereas surgical specialties may have had slower adoption and depressed visit volumes despite telehealth availability during the pandemic [9]. We also chose not to use a historical comparison for visit volume since total visit volumes during the study period were affected by the pandemic.…”

Section: Plos Onementioning

confidence: 99%

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Primary care utilization among telehealth users and non-users at a large urban public healthcare system

et al. 2022

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Telehealth services may improve access to care, but there are concerns around whether availability of telehealth may increase care utilization. We assessed whether usage of telehealth was associated with differential primary care utilization at a large, urban public healthcare system. Using electronic health record data from 23 primary care clinics, we categorized patients as telehealth users and non-users. Then, we compared the number of visits per patient between groups using Welch’s t-tests while stratifying by comorbidity count. We used multivariable Poisson regression to test for associations between telehealth usage and visit count while controlling for other demographic factors. Compared with telehealth non-users, telehealth users had approximately 1 more primary care visit per patient over the year regardless of comorbidity count or other patient characteristics. Availability of telehealth services may be associated with increased primary care utilization in a safety-net setting, though further research on outcomes, costs of care, and patient and clinician experiences is needed to better inform decisions regarding provision and reimbursement of telehealth services.

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Section: Plos Onecontrasting

confidence: 99%

Section: Plos Onecontrasting

confidence: 99%

Section: Plos Onementioning

confidence: 76%

Section: Plos Onementioning

confidence: 99%

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Primary care utilization among telehealth users and non-users at a large urban public healthcare system

et al. 2022

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“…The successful incorporation of telehealth into health care delivery relies upon the fit between the telehealth modality, care delivery context, and disease management approaches [ 9 , 19 , 50 ]. Presumably, not all areas of health care delivery lend themselves equally well to telehealth, but management of certain chronic diseases (CHF, COPD, and T2DM) may provide good opportunity to replace routine in-person care with telehealth.…”

Section: Discussionmentioning

confidence: 99%

Telehealth for the Longitudinal Management of Chronic Conditions: Systematic Review

Lewinski¹,

Walsh²,

Rushton³

et al. 2022

J Med Internet Res

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Background Extensive literature support telehealth as a supplement or adjunct to in-person care for the management of chronic conditions such as congestive heart failure (CHF) and type 2 diabetes mellitus (T2DM). Evidence is needed to support the use of telehealth as an equivalent and equitable replacement for in-person care and to assess potential adverse effects. Objective We conducted a systematic review to address the following question: among adults, what is the effect of synchronous telehealth (real-time response among individuals via phone or phone and video) compared with in-person care (or compared with phone, if synchronous video care) for chronic management of CHF, chronic obstructive pulmonary disease, and T2DM on key disease-specific clinical outcomes and health care use? Methods We followed systematic review methodologies and searched two databases (MEDLINE and Embase). We included randomized or quasi-experimental studies that evaluated the effect of synchronously delivered telehealth for relevant chronic conditions that occurred over ≥2 encounters and in which some or all in-person care was supplanted by care delivered via phone or video. We assessed the bias using the Cochrane Effective Practice and Organization of Care risk of bias (ROB) tool and the certainty of evidence using the Grading of Recommendations Assessment, Development, and Evaluation. We described the findings narratively and did not conduct meta-analysis owing to the small number of studies and the conceptual heterogeneity of the identified interventions. Results We identified 8662 studies, and 129 (1.49%) were reviewed at the full-text stage. In total, 3.9% (5/129) of the articles were retained for data extraction, all of which (5/5, 100%) were randomized controlled trials. The CHF study (1/5, 20%) was found to have high ROB and randomized patients (n=210) to receive quarterly automated asynchronous web-based review and follow-up of telemetry data versus synchronous personal follow-up (in-person vs phone-based) for 1 year. A 3-way comparison across study arms found no significant differences in clinical outcomes. Overall, 80% (4/5) of the studies (n=466) evaluated synchronous care for patients with T2DM (ROB was judged to be low for 2, 50% of studies and high for 2, 50% of studies). In total, 20% (1/5) of the studies were adequately powered to assess the difference in glycosylated hemoglobin level between groups; however, no significant difference was found. Intervention design varied greatly from remote monitoring of blood glucose combined with video versus in-person visits to an endocrinology clinic to a brief, 3-week remote intervention to stabilize uncontrolled diabetes. No articles were identified for chronic obstructive pulmonary disease. Conclusions This review found few studies with a variety of designs and interventions that used telehealth as a replacement for in-person care. Future research should consider including observational studies and studies on additional highly prevalent chronic diseases.

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Post–Emergency Department Virtual Care—More Questions Than Answers

Wray

2022

JAMA Netw Open

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The COVID-19 pandemic spurred rapid and widespread implementation of synchronous virtual care (ie, the delivery of clinical care via telephone or video-based appointments). Although this shift was initially necessary to maintain safe access to medical care during the pandemic, it occurred despite a scarcity of evidence about the equivalence of in-person and virtual care modalities. As health care systems approach some equilibrium in their use of these technologies, we can begin to ask the important question: how well does virtual care work compared with traditional, in-person care?

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Changes in Virtual and In-Person Health Care Utilization in a Large Health System During the COVID-19 Pandemic

Cited by 33 publications

References 3 publications

Primary care utilization among telehealth users and non-users at a large urban public healthcare system

Primary care utilization among telehealth users and non-users at a large urban public healthcare system

Telehealth for the Longitudinal Management of Chronic Conditions: Systematic Review

Post–Emergency Department Virtual Care—More Questions Than Answers

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