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

Abstract

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.

Has increased telehealth access during COVID-19 led to over-utilization of primary care?

“…These findings are in contrast with some recent studies that have shown slightly increased primary care utilization with telehealth availability 12 , 13 . However, Dixit et al’s findings are in line with other studies that have found that telehealth reduces primary care spending 1 .…”

Relative billing complexity of in‐person versus telehealth outpatient encounters

“…Whether the observed lower acuity is due to perceived or actual limitations of the modality and/or patient or clinician comfort addressing more complex medical issues by video is unknown. Regardless, this information can be coupled with data on total care utilisation, [3][4][5][6][7] in-visit behaviour 6 and cost to deliver care 10 as part of understanding the role of video visits.…”

“…Whether these are substitutive or additive to in-person visits is not clear from these data, though prior research from our health system showed slightly increased visit volume for telehealth users compared with telehealth non-users in adult primary care. 7…”

“…[3][4][5] Other evidence has suggested that telehealth visits may be mainly appropriate for less complex cases and may not be able to truly substitute for the value provided in in-person visits. 6,7 Further, whether clinicians and patients may become more comfortable with using telehealth to address more complex issues over time in a peri-pandemic era where more clinicians and patients have been exposed to delivering and receiving care via telehealth is unknown. This may be important because if the distribution of complexity is dynamic, early assessments of telehealth usage in this context should be interpreted with the understanding that they may be more representative of a transitional period rather than an equilibrium state.…”

“…We sought to understand the relative complexity of in-person versus video visits during the COVID-19 pandemic and examine the complexity of video visits over time in specialities with high video visit utilisation. Describing the relative complexity of in-person versus video visits can supplement other data around the effect of telehealth on overall care utilisation [3][4][5][6][7] and improve understanding of the role of telehealth in ambulatory care, which may ultimately inform care design, valuation, and reimbursement.…”