Utilizing a novel unified healthcare model to compare practice patterns between telemedicine and in-person visits

Abstract

Objective Telemedicine practice has been shown to vary from clinical guidelines. Variations in practice patterns may be caused by disruptions in the continuity of care between traditional and telemedicine providers. This study compares virtual and in-person visits in Stanford’s ClickWell Care (CWC) – where patients see the same provider for both visit modalities. Methods Clinical data for two years of patient encounters at CWC from January 2015–2017 (5772 visits) were obtained through Stanford STRIDE. For the 20 most common visit categories, including 17 specific diagnoses, we compared the frequency of prescriptions, labs, procedures, and images ordered, as well as rates of repeat visits. Results For the 17 specific diagnoses, there are no differences in labs ordered. Two diagnoses show differences in images ordered, and four differences in prescriptions. Overall, there are more labs (0.16 virtual, 0.33 in-person p < 0.0001) and images ordered (0.07 virtual, 0.16 in-person, p < 0.0001) for in-person visits – due mainly to general medical exam visits. Repeat visits were more likely after in-person visits (19% virtual, 38% in-person, p < 0.0001), 10 out of 17 specific diagnoses showed differences in visit frequency between visit modalities. Visits for both anxiety (5.3x, p < 0.0001) and depression (5.1x, p < 0.0001) were much more frequent in the virtual setting. Conclusions Prescriptions, labs, and images ordered were similar between in-person and virtual visits for most diagnoses. Overall however, for in-person visits we find increased orders for labs and images, primarily from general medical exams. Finally, for anxiety and depression patients show clear preferences for virtual visits.

Digital Care Providers Antibiotic Prescribing Compared to Traditional Primary Healthcare: A Retrospective Database Study of 332,987 Healthcare Visits in Sweden.

“…There is no similar study that examines the conditions that exist in Sweden, although there are a couple of international studies. A study, which investigated twenty various diagnoses, showed that there was no difference in prescriptions, labs and images ordered by online doctors and physicians met in person [30].…”

“…The study examined antibiotic prescribing based on ATC-codes (Anatomical Therapeutic Chemical . The usage of ATC-codes for identifying antibiotic prescriptions and ICD-10-diagnosis codes are not unique and were commonly employed in many similar studies [27,28,29,30,32]. Infection diagnoses were selected in order to determine if there is a difference in antibiotic prescription patterns between private digital care providers and traditional primary healthcare.…”

“…So, the virtual patients received more often an appropriate diagnosis of viral sinusitis, which implies a lower rate of antibiotic prescribing [27]. Other studies demonstrated no difference [28,29,30,31]. One study found no difference in antibiotic prescribing for acute respiratory infection amongst patients seen by telemedicine and patients seen in person at physician's o ce [28].…”

“…However, the report noticed that patients seeking for anxiety and depression would rather have a virtual visit than in-o ce [30]. A randomised controlled trial demonstrated no difference and showed similar clinical outcomes for patients with diabetes mellitus having telemedicine video consultations compared to in-clinic consultations.…”

“…There are almost no scienti cally reviewed studies that have compared Swedish digital care providers and traditional primary healthcare physicians and their prescribing habits. There are many American studies in this eld [3,27,28,29,30,31,32] and some European ones [6], therefore it is of great value to investigate antibiotic prescribing patterns in Sweden, which is why this study was undertaken.…”