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Virtual 'urgent care' may lead to higher rates of downstream follow-up care

Press releases may be edited for formatting or style | April 06, 2021 Emergency Medicine Health IT Telemedicine
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.

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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.

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