Telehealth follow-ups less effective than in-person for preventing return ED visits

Clinicians' reduced ability to examine patients may cause difference in outcomes

Since coming into widespread use at the start of the COVID-19 pandemic, telehealth has proven useful for many purposes. But preventing repeat emergency department (ED) visits is not among them, a new study finds.

Researchers examined the relation between in-person and telehealth visits following a patient’s ED discharge with the number of subsequent ED or hospital admissions occurring within 30 days of the patient’s initial discharge. Participants included about 13,000 adult patients with 17,000 visits at two Los Angeles EDs from April, 2020 through September, 2021.

They found that among patients who had in-person doctor visits following their ED discharge, 16% had a return ED visit and 4% were admitted to the hospital within 30 days of the discharge. By contrast, 18% of patients whose follow-up visits were via telehealth had a return ED visit, and 5% were hospitalized.

Put another way, patients who had follow-up telehealth visits had 28.3 more ED returns and 10.6 more hospitalizations per 1000 visits than those who had in-person follow-up visits. The differences remained even after adjusting for sociodemographic factors, illness acuity, and medical complexity.

The authors suggest several explanations for the increased health care utilization after telehealth versus in-person follow-up visits. One is that doctors’ reduced ability to examine patients during telehealth visits may make them more likely to refer patients back to the ED for an in-person evaluation of any persisting symptoms.

Another possibility, they say, is that without a physical examination clinicians may not be able to communicate as well with patients, making them less able to fully evaluate or intervene in an illness, thereby causing the patient’s condition to deteriorate and a need for hospitalization.

In addition, the authors cite previous studies showing that doctors don’t think telehealth is well suited to evaluating problems that represent a large share of post-ED follow-up visits, such as chest pain, abdominal pain and shortness of breath.

“As policy makers, health systems, and patients consider how to use telehealth to increase access to care, these findings suggest that telehealth may not be the best modality for all types of encounters, including many post-ED discharge follow-up visits,” they conclude.

The study, Association Between In-Person vs Telehealth Follow-up and Rates of Repeated Hospital Visits Among Patients Seen in the Emergency Department”, was published October 25 on JAMA Network Open.