ED visits more likely when outside physicians handle virtual care

© Galina Barskaya

Patients were more likely to visit the emergency department (ED) within a week of telehealth meetings with outside physicians, instead of their own doctors.

Researchers examined almost 5.23 million patients with family physicians and who made virtual visits with them and with outside physicians. Among more than 1.88 million patients, “those who saw an outside physician were 66% more likely to visit an emergency department within seven days than those who had a virtual visit with their own physician,” the study said.

“This finding suggests that virtual care with an outside physician is associated with more emergency visits,” said the report, “Virtual Visits With Own Family Physician vs Outside Family Physician and Emergency Department Use,” published in JAMA Network Open. “These findings suggest that primary care virtual visits may be best used within an existing clinical relationship.”

Past research has demonstrated that continuity between physicians and patients leads to better health outcomes and lower costs, the study said. But there has been little review about virtual primary care to compare ongoing relationships with care provided outside those relationships, such as direct-to-consumer telemedicine.

The researchers used population-based administrative data from Ontario, Canada, where family physicians provide most primary care and almost 80% of the population is enrolled to a family physician. The study period took place April 1, 2021, to March 31, 2022.

For the patients more likely to head to the ED after virtual encounters with outside physicians, the likelihood led to one additional ED visit per 77 outside virtual visits. The increase in risk of seven-day ED visits was greater for younger age groups, with youths aged 18 years or younger most at risk, followed by adults aged 18 to 64 years, then older adults age 65 years or older.

The ED visits were front loaded, usually on days one or two of the seven-day period, suggesting the virtual visits could be used for triaging to identify patients who would benefit from in-person assessments, the study said.

“Direct-to-consumer telemedicine physicians may direct patients to an in-person follow-up visit, either immediately or if symptoms persist; alternatively, physicians may direct patients to the emergency department for a condition perceived to be urgent,” the researchers said. “Finally, some patients may choose the emergency department even if not suggested by a physician if they perceive this to be their only option for a timely in-person exam.”

Among the study limitations, the researchers noted some outside-physician virtual visits may have averted ED visits for patients who could not reach their own physicians in a timely manner. There is no way to identify those patients or contributing factors such as hours of operation, availability of physicians, or challenges making appointments.