Virtual "Urgent Care" may Lead to Higher Rates of Downstream Follow-Up Care

Even before the pandemic made telehealth a hot topic, people with minor urgent health needs had started to turn to companies that offer on-demand video chats with physicians that they don't normally see.

Insurers and employers even started buying access to this direct-to-consumer form of virtual care, hoping it might reduce in-person care, including emergency department visits.

But a new University of Michigan study casts some doubt on whether that will actually happen.

Published in the April issue of Health Affairs, the study finds that patients who had an on-demand virtual care visit for an upper respiratory infection in the three years before the pandemic began were slightly more likely to receive additional follow-up care than similar patients who had their first visit in person.

The study compared data from more than 28,700 virtual visits with data from more than 57,400 in-person visits for acute respiratory infections in 2016 through 2019. Those visits, and any follow-up care, were all covered by a large insurer. All the virtual visits were done through a direct-to-consumer telehealth company that the insurer had partnered with.

The authors say it's important to note that the vast majority of the patients did not require any further care for their infections, which included ear infections, bronchitis, laryngitis, sore throat and pneumonia.

But 10.3% of the patients first seen through a direct-to-consumer telehealth visit ended up having an in-person visit in the next week, compared with 5.9% of those who had their first visit in person. This includes second telemedicine visits or visits to clinics, urgent care centers and emergency rooms.

Less than 1% of all the patients in the study visited an emergency department after their initial visit, and the percentage was only slightly lower among people whose first visit was through a direct-to-consumer virtual provider compared with those who started with an in-person visit.

Kathleen Li, M.D., M.S., is the first author of the paper and an alumna of the IHPI Scholars program at the U-M Institute for Healthcare Policy and Innovation, and conducted the study as part of the institute's telehealth research effort.

She notes that direct-to-consumer telehealth providers usually don't have access to patients' electronic health records, so they may not know the patient's full medical history or underlying conditions.

As an emergency physician at Michigan Medicine, Li notes that often patients will come to the ED after trying to reach their primary care physician and not being able to get an appointment quickly.

Li was a co-author on a recent National Poll on Healthy Aging report from IHPI that found that 1 in 8 older adults had gone to the ED after not being able to get a timely appointment with their regular provider.

"If an appointment with a patient's regular provider isn't available right away, or the patient isn't able to get to the clinic in person during standard business hours, on-demand virtual care does offer convenience," she says. "But things have changed so much with the pandemic, and more primary care providers are now offering telehealth visits with themselves or members of their teams. It remains to be seen how primary care-based telehealth models will affect downstream use and cost of care."

Senior author Chad Ellimoottil, M.D., M.Sc., who directs IHPI's Telehealth Research Incubator, says that while the insurance claims data in the study were available to the IHPI team, that may not be the case for most direct-to-consumer telehealth, especially if the patient pays directly rather than using insurance.

"As more companies enter the marketplace of direct-to-consumer telehealth, it's going to be important to understand the outcomes for patients, and the broader implications for the health care system," says Ellimoottil, a urologist and telehealth researcher. "Data transparency is essential. We need to be able to directly compare outcomes of patients seen by direct-to-consumer telehealth companies with in-person care and with telemedicine provided by the patient's own primary care provider."

For employers that offer a direct-to-consumer telehealth option through their benefits package, Li says, the bottom line comes down to balancing how much the instant access may result in an increase in visits or additional follow-up care, against the benefit of less time spent away from work and a potential reduction in inappropriate emergency department visits.

"We need to optimize both the use of telehealth and of in-person emergency care," she says.

Kathleen Yinran Li, Ziwei Zhu, Sophia Ng, Chad Ellimoottil.
Direct-To-Consumer Telemedicine Visits For Acute Respiratory Infections Linked To More Downstream Visits.
Health Affairs 2021. doi: http://dx.doi.org/10.1377/hlthaff.2020.01741

Most Popular Now

Researchers Invent AI Model to Design Ne…

Researchers at McMaster University and Stanford University have invented a new generative artificial intelligence (AI) model which can design billions of new antibiotic molecules that are inexpensive and easy to...

Two Artificial Intelligences Talk to Eac…

Performing a new task based solely on verbal or written instructions, and then describing it to others so that they can reproduce it, is a cornerstone of human communication that...

Greater Manchester Reaches New Milestone…

Radiologists and radiographers at Northern Care Alliance NHS Foundation Trust have become the first in Greater Manchester to use the Sectra picture archiving and communication system (PACS) to report on...

Powerful New AI can Predict People'…

A powerful new tool in artificial intelligence is able to predict whether someone is willing to be vaccinated against COVID-19. The predictive system uses a small set of data from demographics...

Alcidion and Novari Health Forge Strateg…

Alcidion Group Limited, a leading provider of FHIR-native patient flow solutions for healthcare, and Novari Health, a market leader in waitlist management and referral management technologies, have joined forces to...

AI-Based App can Help Physicians Find Sk…

A mobile app that uses artificial intelligence, AI, to analyse images of suspected skin lesions can diagnose melanoma with very high precision. This is shown in a study led from...

ChatGPT can Produce Medical Record Notes…

The AI model ChatGPT can write administrative medical notes up to ten times faster than doctors without compromising quality. This is according to a new study conducted by researchers at...

Can Language Models Read the Genome? Thi…

The same class of artificial intelligence that made headlines coding software and passing the bar exam has learned to read a different kind of text - the genetic code. That code...

Advancing Drug Discovery with AI: Introd…

A transformative study published in Health Data Science, a Science Partner Journal, introduces a groundbreaking end-to-end deep learning framework, known as Knowledge-Empowered Drug Discovery (KEDD), aimed at revolutionizing the field...

Study Shows Human Medical Professionals …

When looking for medical information, people can use web search engines or large language models (LLMs) like ChatGPT-4 or Google Bard. However, these artificial intelligence (AI) tools have their limitations...

Wanted: Young Talents. DMEA Sparks Bring…

9 - 11 April 2024, Berlin, Germany. The digital health industry urgently needs skilled workers, which is why DMEA sparks focuses on careers, jobs and supporting young people. Against the backdrop of...

Shared Digital NHS Prescribing Record co…

Implementing a single shared digital prescribing record across the NHS in England could avoid nearly 1 million drug errors every year, stopping up to 16,000 fewer patients from being harmed...