JMIR Publications

ABSTRACT

Background:

Telemedicine has increased in use and impact in recent years for providing healthcare services to patients, reducing the requirement for physical in-person encounters. T

Objective:

his study aimed to compare the utilization of telemedicine for outpatient visits versus in-person visits across different medical specialties, assess its association with clinical outcomes and examine the influence of patient and physician characteristics on telemedicine use in a large tertiary teaching hospital.

Methods:

The study cohort consisted of adult patients, who attended outpatient clinics in five medical fields (psychiatry, endocrinology, nephrology, hemato-oncology, and gastroenterology) in 2019 and survived until the beginning of 2020. Telemedicine utilization during the period of 2019-2021 was the main exposure of interest. The primary outcomes were emergency department referrals and hospitalizations. The analysis employed multivariate mixed models and subgroup analysis by patient demographic characteristics, chronic disease medical fields and physicians’ characteristics.

Results:

The cohort included 32,445 patients. In 2019, 99.6% of visits were in-person and by 2020-2021, 22% of patients had utilized telemedicine. Telemedicine patients were slightly older (SMD=0.281), with a higher comorbidity burden than in-person patients or patients without visits (SMD=0.328). Pre-surge telemedicine users had higher rates of emergency department referrals (IRR 1.15, 95% CI: 1.09,1.21) and hospitalizations (IRR 1.14, 95% CI:1.08,1.20), these ratios decreased during the surge (IRR 1.1, 95% CI:1.06,1.16 and IRR 1.12, 95% CI: 1.05, 1.19), narrowing the gap between telemedicine and in-person care. Healthcare providers with higher telemedicine usage had reduced rates of ED referrals and hospitalizations.

Conclusions:

This study supports the safety and effectiveness of telemedicine as an alternative to in-person visits for managing various medical conditions. It highlights the importance of healthcare providers’ perspectives and utilization of virtual visits. Telemedicine should be tailored to individual patient-physician needs, considering the nature of the patient’s disease. This study supports the safety and effectiveness of telemedicine as an alternative to in-person visits for managing various medical conditions. It highlights the importance of healthcare providers' perspectives and utilization of virtual visits. Telemedicine should be tailored to individual patient-physician needs, considering the nature of the patient's disease.