A Kaiser Permanente Division of Research study reveals that in-person follow-up rates are higher after telehealth appointments than traditional office visits, particularly in cases involving physical discomfort. Examining 1.5 million adult patients between April 2021 and December 2021, the study found that 6.2 percent of video visits and 7.6 percent of telephone visits led to in-person follow-ups within seven days, surpassing the 1.3 percent rate for in-person visits. Medication and antibiotic prescription rates were similar across modalities. The study also highlighted differences in follow-up tendencies for various health concerns, emphasizing the benefits of telehealth in select scenarios.
Recent research conducted by the Kaiser Permanente Division of Research has unveiled a surprising trend in healthcare. In a study published in the Annals of Internal Medicine, it was discovered that in-person follow-up rates following telehealth appointments are higher than those after traditional office visits, particularly in cases involving physical pain. This study, analyzing data from 1.5 million adult patients between April 2021 and December 2021, sheds light on the evolving landscape of healthcare delivery, where telehealth is emerging as a viable and effective alternative to in-person care.
The study was a retrospective analysis utilizing administrative and EHR data from a substantial sample of 1.5 million adult patients receiving primary care within a large integrated healthcare system. The data spanned from April 2021 to December 2021 and included patients of varying demographics: 26.5 percent aged 65 or older, 54.9 percent female, 31.8 percent with chronic health conditions, 22.2 percent Asian, 7.4 percent Black, 22.3 percent Hispanic, and 46.5 percent White.
The research investigated different treatment outcomes for both in-person and telehealth visits, encompassing aspects such as medication or antibiotic prescriptions. Additionally, it explored follow-up visits, categorizing them as either in-person visits to the primary care office or emergency department within a seven-day timeframe.
Among the 2.3 million primary care visits analyzed, 50.8 percent occurred via telehealth—comprising 19.5 percent video and 31.3 percent telephone consultations. Notably, the study revealed that 6.2 percent of video visits and 7.6 percent of telephone visits resulted in subsequent in-person follow-up visits within seven days. These figures, although relatively low, surpassed the seven-day in-person follow-up rate following traditional in-person visits, which stood at a mere 1.3 percent.
Furthermore, the research indicated that 1.6 percent of in-person visits, 1.8 percent of video visits, and 2.1 percent of telephone visits led to in-person emergency department (ED) visits.
Prescription rates were relatively consistent across different consultation methods, with 46.8 percent of in-person visits, 38.4 percent of video visits, and 34.6 percent of telephone visits resulting in medication prescriptions. Antibiotic prescribing followed a similar pattern, occurring in 6.6 percent of in-person visits, 6.6 percent of video visits, and 6.7 percent of telephone visits.
Dr. Anjali Gopalan, a Kaiser Permanente research scientist and senior physician, emphasized, “We aren’t seeing over prescription in the virtual care setting, given the potential for providers to order tests or antibiotics cautiously without a physical examination. The ideal future approach would be to strike a balance between patient preference for convenience and clinical appropriateness when choosing the primary care modality.”
In addition to examining overall follow-up rates, the researchers investigated the clinical characteristics associated with follow-ups following virtual care. Notably, in-person follow-ups were more likely after virtual visits for abdominal or musculoskeletal pain and less likely after virtual visits addressing mental health concerns.
Mary Reed, DrPH, the lead author of the study, remarked, “This finding aligns with clinical reasoning because a clinician may find it necessary to conduct a physical examination for patients experiencing persistent physical pain, whereas mental health-related visits are more amenable to virtual interactions. Importantly, the data shows that patient return rates to care after telemedicine encounters are relatively limited.”
This study builds upon previous research conducted by Kaiser Permanente, which also explored in-person follow-up rates after telehealth visits. In an earlier study published in January, a research team led by Mary Reed examined in-person follow-ups following telephone-only and video-only telehealth visits during the early stages of the pandemic. Their findings indicated that in-person follow-up visits and emergency department visits were infrequent following both video and telephone-based consultations. However, the adjusted rates of seven-day in-person follow-up visits were 0.7 percent lower after video visits compared to telephone visits. Similarly, adjusted emergency department visits and hospitalization rates were lower following video visits than telephone consultations.
