Comparing telehealth to traditional office visits for patient management in the COVID-19 pandemic: A cross-sectional study in a respiratory assessment clinic

Abstract

Introduction The aim of this study was to examine whether telehealth is as safe and effective as traditional office visits in assessing and treating patients with symptoms consistent with COVID-19. Methods In this retrospective cross-sectional study, the primary outcome was any 14-day related healthcare follow-up event(s). Secondary outcomes were the type of 14-day related follow-up event including hospital admission, emergency department visit, office visit, telehealth visit and/or multiple follow-up visits. Individual visit types were identified due to the significant difference between a hospital admission and an office visit. Logistic regressions were done using the predictors of visit type, age, gender and comorbidities and the primary outcome variable of a related follow-up visit and then by follow-up type: hospital admission, emergency department visit or office visit. Results Of 1305 visits, median age was 42.3 years and 65.8% were female. Traditional office visits accounted for 741 (56.8%) of initial visits, while 564 (43.2%) visits occurred via telehealth. One hundred and forty-six (25.9%) of the telehealth visits resulted in a 14-day related healthcare follow-up visit versus 161 (21.7%) of the office visits (adjusted odds ratio (OR) 1.22, 95% CI 0.94–1.58). Discussion There was no significant difference in related follow-ups of initial telehealth visits compared to initial office visits including no significant difference in hospital admission or emergency department visits. These findings suggest that based on follow up healthcare utilization, telehealth may be a safe and effective option in assessing and treating patients with respiratory symptoms as the COVID-19 pandemic continues.

Approaches to Evaluations of Virtual Care in Primary Care

“…Of these, 3 were systematic reviews (SRs) [11][12][13] and 8 were non-randomized comparative studies. 8,10,[14][15][16][17][18][19] For additional information, 7 publications from the grey literature search [20][21][22][23][24][25][26] were also included. Altogether, 18 publications were included to address the research questions; of these, 7 were evaluation guidance documents being used in various countries to evaluate virtual care in primary care settings and 11 were evaluations of virtual care in primary care settings.…”

“…Phillips et al (2021) evaluated the comparative effectiveness of virtual care to in-person care in a respiratory assessment centre and found no statistical differences between virtual care versus in-person visits for hospital admissions (2.0% versus 2.8%, respectively), emergency department visits (5.0% versus 3.9%, respectively), or follow-up virtual care appointments (11.0% versus 9.7%, respectively) within a 14-day window. 18 Patients with an initial in-person visit had a higher percentage of related hospital admissions (13.0% versus 7.5% in the in-person versus virtual care groups, respectively) and higher related follow-up virtual care visits (44.7% versus 42.5% in the in-person versus virtual care groups, respectively) within a 14-day window. 18 Han et al ( 2020) performed an SR focused on antibiotic prescribing among primary health care settings and reported on studies that investigated follow-up visit rates after initial consultation for the same presentation but evidence was mixed regarding whether remote consultations were more likely to be followed up with another consultation for the same condition.…”

“…18 Patients with an initial in-person visit had a higher percentage of related hospital admissions (13.0% versus 7.5% in the in-person versus virtual care groups, respectively) and higher related follow-up virtual care visits (44.7% versus 42.5% in the in-person versus virtual care groups, respectively) within a 14-day window. 18 Han et al ( 2020) performed an SR focused on antibiotic prescribing among primary health care settings and reported on studies that investigated follow-up visit rates after initial consultation for the same presentation but evidence was mixed regarding whether remote consultations were more likely to be followed up with another consultation for the same condition. 11…”

“…Identified evaluations of virtual care with a focus on the economic aspect were limited to 2 SRs, 12,13 while 4 studies assessed health care utilization. [11][12][13]18 Carrillo de Albornoz et al ( 2021) performed an SR focused on primary care including mental health and allied health services. 12 The authors reported that virtual care reduced health care cost and utilization among various appointment types within primary care (e.g., mental health and smoking cessation) and allied health services (e.g., speech therapy and postpartum care).…”

“…One of the included studies found that age was associated with an increased risk of hospitalization if the initial visit was a virtual care visit versus an in-person visit. 18 Overall, the included evidence is limited in its generalizability because of considerable differences within and between treatment (e.g., virtual care versus in-person care) groups and is limited in the Canadian context. The quality of included evidence is low and findings may be associated with a high risk of bias, as 8 of the 11 evaluations were non-randomized comparative studies.…”