Health care utilization following “digi-physical” assessment compared to physical assessment for infectious symptoms in primary care

Abstract

Background The use of chat-based digital visits (eVisits) to assess infectious symptoms in primary care is rapidly increasing. The “digi-physical” model of care uses eVisits as the first line of assessment while assuming a certain proportion of patients will inevitably need to be further assessed through urgent physical examination within 48 h. It is unclear to what extent this approach can mitigate physical visits compared to assessing patients directly using office visits. Methods This pre-COVID-19-pandemic observational study followed up “digi-physical” eVisit patients (n = 1188) compared to office visit patients (n = 599) with respiratory or urinary symptoms. Index visits occurred between March 30th 2016 and March 29th 2019. The primary outcome was subsequent physical visits to physicians within two weeks using registry data from Skåne county, Sweden (Region Skånes Vårddatabas, RSVD). Results No significant differences in subsequent physical visits within two weeks (excluding the first 48 h) were noted following “digi-physical” care compared to office visits (179 (18.0%) vs. 102 (17.6%), P = .854). As part of the “digital-physical” concept, a significantly larger proportion of eVisit patients had a physical visit within 48 h compared to corresponding office visit patients (191 (16.1%) vs. 19 (3.2%), P < .001), with 150 (78.5%) of these eVisit patients recommended some form of follow-up by the eVisit physician. Conclusions Most eVisit patients (68.9%) with respiratory and urinary symptoms have no subsequent physical visits. Beyond an unavoidable portion of patients requiring urgent physical examination within 48 h, “digi-physical” management of respiratory and urinary symptoms results in comparable subsequent health care utilization compared to office visits. eVisit providers may need to optimize use of resources to minimize the proportion of patients being assessed both digitally and physically within 48 h as part of the “digi-physical” concept. Trial registration Clinicaltrials.gov identifier: NCT03474887.

Telemedicine in Swedish primary health care - a web-based survey exploring patient satisfaction

“…A pre-pandemic study from Sweden concluded that TM visits for respiratory or urinary symptoms resulted in a larger proportion of physical revisits in the first 48 hours after the TM visit but similar utilization of physical visits the following 2 weeks, compared to patients with an initial physical visit [ 10 ]. Another Swedish study concluded that only a few TM consultations led to further physical contact and that the general users were satisfied with their visit [ 4 ].…”

Effectiveness and safety of asynchronous telemedicine consultations in general practice: a systematic review

“…Most asynchronous platforms were available 24 hours, 7 days a week. Some had expected response times, ranging from 15 minutes 34 , 35 to 48 hours. 43 Two studies found patients completing virtual consultations reported shorter symptom durations before consultation than those who had face-to-face consultations.…”

“…One study found diagnoses were made based on symptoms following 25% of asynchronous consultations, compared with 14.2% of face-to-face consultations. 34 , 35 Face-to-face consultations resulted in more investigations, 36 but more inappropriate diagnoses. 37 …”

“…Studies reported low asynchronous telemedicine use before the pandemic; up to seven consultations per 1000 patients per month. 31 – 33 , 35 Three studies reported patient use of asynchronous telemedicine increased gradually before the pandemic 26 , 31 – 33 , 40 and in 2016 20% of UK general practices planned to introduce it. 49 …”

A Note on the Effects of Digital Primary Health Care on Utilization: Concepts, Evidence, and Descriptive Analysis of Non-Experimental Register Data from Sweden

“…Finally, in a recent study, Entezarjou et al (2022) used data from a set of primary care clinics in southern Sweden to investigate the extent to which users of a blended digital-physical care model (asynchronous eVisits; n = 1,188) made more follow-up visits compared with an initial in-person visit (n = 599) during a two-week follow-up period. They find that patients using the eVisit model of care had a higher proportion of a physical revisit within 48 hours, but not over the entire follow-up period.…”