Journal article
Healthcare Utilization Differences Among Primary Care Patients Using Telemedicine in the Veterans Health Administration: a Retrospective Cohort Study
Journal of general internal medicine : JGIM, Vol.39(S1), pp.109-117
02/2024
DOI: 10.1007/s11606-023-08472-1
PMCID: PMC10937860
PMID: 38252240
Abstract
The COVID-19 pandemic encouraged telemedicine expansion. Research regarding follow-up healthcare utilization and primary care (PC) telemedicine is lacking.
To evaluate whether healthcare utilization differed across PC populations using telemedicine.
Retrospective observational cohort study using administrative data from veterans with minimally one PC visit before the COVID-19 pandemic (March 1, 2019-February 28, 2020) and after in-person restrictions were lifted (October 1, 2020-September 30, 2021).
All veterans receiving VHA PC services during study period.
Veterans' exposure to telemedicine was categorized as (1) in-person only, (2) telephone telemedicine (≥ 1 telephone visit with or without in-person visits), or (3) video telemedicine (≥ 1 video visit with or without telephone and/or in-person visits). Healthcare utilization 7 days after index PC visit were compared. Generalized estimating equations estimated odds ratios for telephone or video telemedicine versus in-person only use adjusted for patient characteristics (e.g., age, gender, race, residential rurality, ethnicity), area deprivation index, comorbidity risk, and intermediate PC visits within the follow-up window.
Over the 2-year study, 3.4 million veterans had 12.9 million PC visits, where 1.7 million (50.7%), 1.0 million (30.3%), and 649,936 (19.0%) veterans were categorized as in-person only, telephone telemedicine, or video telemedicine. Compared to in-person only users, video telemedicine users experienced higher rates per 1000 patients of emergent care (15.1 vs 11.2; p < 0.001) and inpatient admissions (4.2 vs 3.3; p < 0.001). In adjusted analyses, video versus in-person only users experienced greater odds of emergent care (OR [95% CI]:1.18 [1.16, 1.19]) inpatient (OR [95% CI]: 1.29 [1.25, 1.32]), and ambulatory care sensitive condition admission (OR [95% CI]: 1.30 [1.27, 1.34]).
Telemedicine potentially in combination with in-person care was associated with higher follow-up healthcare utilization rates compared to in-person only PC. Factors contributing to utilization differences between groups need further evaluation.
Details
- Title: Subtitle
- Healthcare Utilization Differences Among Primary Care Patients Using Telemedicine in the Veterans Health Administration: a Retrospective Cohort Study
- Creators
- Amy M J O'Shea - Department of Internal Medicine, University of Iowa Carver College of Medicine, Iowa City, IA, 52242, USA. amy.oshea@va.govKailey Mulligan - Iowa City VA Health Care SystemPaige Carlson - Department of Internal Medicine, University of Iowa Carver College of Medicine, Iowa City, IA, 52242, USABjarni Haraldsson - Iowa City VA Health Care SystemMatthew R Augustine - James J. Peters VA Medical CenterPeter J Kaboli - Iowa City VA Health Care SystemStephanie L Shimada - Bedford VA Research Corporation
- Resource Type
- Journal article
- Publication Details
- Journal of general internal medicine : JGIM, Vol.39(S1), pp.109-117
- DOI
- 10.1007/s11606-023-08472-1
- PMID
- 38252240
- PMCID
- PMC10937860
- NLM abbreviation
- J Gen Intern Med
- ISSN
- 0884-8734
- eISSN
- 1525-1497
- Grant note
- CIN13-412 / Health Services Research and Development
- Language
- English
- Electronic publication date
- 01/22/2024
- Date published
- 02/2024
- Academic Unit
- Epidemiology; General Internal Medicine; Internal Medicine
- Record Identifier
- 9984548851102771
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