Since the beginning of the pandemic, few studies have investigated the association of telehealth with outcomes of care, including patterns of care use after the initial encounter. New research published in JAMA Network Open set out to do just that, using a cohort of 40.7M US adults with commercial health coverage to examine the difference in outcomes between telehealth versus in-person encounters.
The study assessed Blue Cross and Blue Shield members from July 1, 2019, to December 31, 2020. Outcomes of care were assessed 14 days after initial encounters and included follow-up encounters of any kind, ED visits, and hospitalizations.
The key finding of the study was that telehealth has the potential to result in duplicative care, depending largely on the patient’s condition type. Telehealth patients with acute conditions were more likely to have a follow-up encounter than in-person patients, while telehealth patients with chronic conditions were less likely to require follow-up.
In the cohort with acute conditions, the odds ratios for patients with an initial telehealth encounter were 1.44 for a follow-up of any kind and 1.11 for an ED encounter.
- Ex: Patients with an acute upper respiratory tract infection episode were 65% more likely to have a follow-up if their initial encounter was a telehealth visit, compared to in-person.
The chronic condition cohort showed contrasting results, with odds ratios of 0.94 for follow-ups of any kind if the initial encounter was via telehealth.
- Ex: Patients with essential hypertension were 37% less likely to have a follow-up if their initial encounter was a telehealth visit, compared to in-person.
For those that like to dive into the data, this table breaks down patterns of subsequent care by the clinical condition.
The contrasting patterns of telehealth follow-up care for acute and chronic conditions are relevant to both policy makers and providers. Telehealth use for the management of chronic conditions appears comparable, or even more efficient, than in-person care, with the opposite looking true for acute conditions. This trend was strongest for acute respiratory infections, but that also feels like a pretty natural result for a study conducted during a respiratory-related pandemic.