Most primary care telehealth visits don’t need in-person follow-ups

Visits with internists least likely to require in-person follow-ups, pediatric visits most likely

When telehealth use mushroomed at the height of the COVID-19 pandemic many primary care physicians worried that remote visits wouldn’t meet their patients’ health needs and a lot of them would require in-person, follow-up visits. But a newly-released study finds those concerns were largely unfounded.

The study from Epic Research evaluated 18.6 million telehealth visits with family, general internal and pediatric practitioners between March 2020 and October 2022. It found that 61% of the visits didn’t require an in-person follow-up visit in the same specialty within three months of the initial remote visit. Those findings might even underestimate how many visits didn’t require an in-person follow-up, according to the study’s authors.

“Primary care physicians treat a wide variety of conditions, so the subsequent in-person visit might not have been related to the reason for the telehealth visit,” they write. “For example, a telehealth visit for an upper respiratory infection wouldn’t affect whether a patient has a normal wellness exam scheduled in the next three months, yet in our study that would be counted as having had in-person follow-up.”

Internal medicine visits were the least likely to require in-person follow-ups (63%), followed by family medicine (60%) and pediatrics (54%). Broken down by payer, the study found that 76% of self-paying didn’t have an in-person follow-up visit within 90 days. The rate was 63% among those with commercial or employer-sponsored insurance and 55% for both Medicare and Medicaid beneficiaries.

The findings were similar to those of an earlier Epic Research study of telehealth visits in 33 non-primary care specialties, which found that only three (geriatrics, fertility and obstetrics) had in-person follow-up rates of 50% or more. Still, the results of the primary care study were somewhat surprising, said Danessa Sandmann, MPH, head of operations for Epic Research.

“I think many hypothesized that primary care would have more frequent in-person follow-ups just based on the nature of the interactions patients have with their primary care providers,” Sandmann said. “But our study found that even in primary care specialties, more often than not, the patient doesn’t have an in-person visit in the three months following their telehealth visit, suggesting that telehealth can be an alternate rather than duplicative mode of providing care in many cases.”

Information for the study came from Cosmos, a data set drawing from Epic electronic health record systems used in treating more than 180 million patients at about 1,100 hospitals and 22,500 clinics.

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