A real-world analysis of 73,560 patient encounters shows that online consultations rarely require follow-up for several everyday conditions, suggesting strong usability and convenience. However, it also reveals how age, insurance coverage, and prior digital experience shape who chooses telemedicine in the first place.
Study: Electronic Visit Use and Resolution Rates for Adult Outpatient Conditions in an Integrated Care Setting. Image Credit: Ground Picture / Shutterstock.com
How virtual visits compare in practice
Despite the widespread adoption of telemedicine services, a lack of clinical data remains on the effectiveness and outcomes of e-visits, with one study raising concerns that physicians involved in these services may inaccurately prescribe antibiotics. In a recent study published in JAMA Network Open, researchers compared the efficacy of e-visits in clinical settings where other types of visits are available.
Electronic visits, also known as e-visits, are a form of telemedicine that enables patients to communicate with a healthcare professional for diagnosis and treatment recommendations via video conferencing, online chat, or asynchronous messaging. Some large healthcare systems, as well as direct-to-customer companies, have increasingly incorporated e-visits into their practice to improve the convenience, accessibility, and cost-effectiveness of healthcare services for patients.
Four common outpatient issues assessed for outcomes
Given the potential use of e-visits in overcoming the ongoing national shortage of primary care physicians, the researchers of the current study explored the use and outcomes of structured e-visits in clinical settings where patients have the option to select different types of visits for common outpatient conditions. The current study was conducted at Kaiser Permanente Northern California (KPNC), where The Permanente Medical Group provides both inpatient and outpatient care for about 4.6 million patients.
Adult individuals who previously attended e-visits, telephone/video appointment visits, or physician’s office visits between January 1, 2024, and December 31, 2024, were included in the analysis. These patients were treated for one of four common outpatient conditions, including urinary tract infection, seasonal allergies, acne, and international travel advice.
The electronic health records of all study participants were analyzed to compare the percentage of e-visits with other types of visits, as well as the rates of subsequent follow-up visits within seven days.
Low seven-day return rate after e-visits
A total of 73,560 initial visits were reported, of which 34,895 were e-visits, 20,647 were telephone visits, 3,135 were video visits, and 14,883 were physicians’ office visits. Among these initial visits, 47,264 were for urinary tract infections, 15,646 for seasonal allergies, 6,426 for acne, and 4,224 for international travel advice.
Among the four included outpatient conditions, the highest percentage of e-visits was associated with urinary tract infection, followed by international travel advice, seasonal allergy, and acne. Patients between 18 and 29 years of age, who were White, English-speaking, commercially insured, or had fewer comorbidities, were more likely to choose e-visits for urinary tract infections.
For acne, e-visits were least likely among patients aged 18 to 29 years. For seasonal allergy, e-visits were most frequently used by patients between 30 and 39 years of age, whereas patients 65 years or older were least likely to use these services for seasonal allergy complaints. For international travel advice, e-visits were most frequently used by those between 30 and 49 years of age.
After e-visits, follow-up visits for the same diagnosis within seven days were infrequent for all four conditions. Specifically, the lowest follow-up visits after initial e-visits were for urinary tract infection and international travel advice, as compared to other types of visits.
After initial e-visits for urinary tract infection, the likelihood of follow-up visits was higher among patients 65 years and older, Hispanic and Asian patients, as well as those with Medicaid insurance coverage. For other conditions, the risk of follow-up visits did not vary with patient characteristics.
E-visits perform comparably, not proven superior
The study highlights the growing popularity of e-visits for diagnosing and treating common health conditions in clinical settings where patients have timely access to various types of visits, including telephone, video, and physician’s office visits. Follow-up outcomes suggest that e-visits perform similarly to other visit types in resolving symptoms over seven days. However, the study did not assess clinical quality, prescribing appropriateness, or symptom severity. E-visits were associated with similar or comparable efficacy in terms of follow-up visit rates to other types of visits in resolving diagnosed conditions within seven days.
A large-scale implementation of new telemedicine modalities in clinical settings requires careful quality monitoring. The e-visits in this study were created and delivered by the same medical group responsible for the comprehensive care of the patients who selected them.
The rates of follow-up visits within seven days of initial e-visits were low for almost all health conditions studied. For urinary tract infection, the frequency of follow-up visits after initial e-visits was even lower than other visit types.
Importantly, these findings are not indicative of inherently superior efficacy of e-visits as compared to other visit types. Furthermore, if patients with lower acuity preferentially select e-visits, their lower follow-up visit rates might have been due to selection bias.
Patients with a history of using e-visits were more likely to select e-visits for future healthcare needs, suggesting that patients' prior experience with health information technology may influence their choice of e-visits.
Researchers receive NPB grant to develop online food allergy support tool