Telemedicine Familiarity and Post-Disaster Utilization of Emergency and Hospital Services for Ambulatory Care Sensitive Conditions

Friedman, Rachel S C; Carpenter, Daniel; Shaver, Julia; McDermott, Shannon; Voelkel, Jackson

doi:10.1016/j.amepre.2021.12.025

Cited by 9 publications

(6 citation statements)

References 23 publications

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“…Prior to the pandemic, several studies suggested that virtual care could reduce ED and other hospital use, specifically for rural populations, 37 older populations, 38 and after a natural disaster. 39 Following the start of the pandemic, 1 study found that practices with a high level of virtual care use had a small increase in ACSC-related visits compared with practices with a medium level of virtual care use, but differences disappeared when acute and chronic ACSC were evaluated separately. 11 Other studies found that virtual care use during the pandemic was higher among patients who had more severe illness, suggesting that virtual care supported care continuity.…”

Section: Discussionmentioning

confidence: 99%

Virtual Care and Emergency Department Use During the COVID-19 Pandemic Among Patients of Family Physicians in Ontario, Canada

Kiran

Green

Strauss³

et al. 2023

JAMA Netw Open

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ImportanceThe COVID-19 pandemic has played a role in increased use of virtual care in primary care. However, few studies have examined the association between virtual primary care visits and other health care use.ObjectiveTo evaluate the association between the percentage of virtual visits in primary care and the rate of emergency department (ED) visits.Design, Setting, and ParticipantsThis cross-sectional study used routinely collected administrative data and was conducted in Ontario, Canada. The sample comprised family physicians with at least 1 primary care visit claim between February 1 and October 31, 2021, and permanent Ontario residents who were alive as of March 31, 2021. All residents were assigned to physicians according to enrollment and billing data.ExposureFamily physicians’ virtual visit rate was the exposure. Physicians were stratified by the percentage of total visits that they delivered virtually (via telephone or video) during the study period (0% [100% in person], &gt;0%-20%, &gt;20%-40%, &gt;40%-60%, &gt;60%-80%, &gt;80% to &lt;100%, or 100%).Main Outcomes and MeasuresPopulation-level ED visit rate was calculated for each stratum of virtual care use. Multivariable regression models were used to understand the relative rate of patient ED use after adjusting for rurality of practice, patient characteristics, and 2019 ED visit rates.ResultsData were analyzed for a total of 13 820 family physicians (7114 males [51.5%]; mean [SD] age, 50 [13.1] years) with 12 951 063 patients (6 714 150 females [51.8%]; mean [SD] age, 42.6 [22.9] years) who were attached to these physicians. Most physicians provided between 40% and 80% of care virtually. A higher percentage of the physicians who provided more than 80% of care virtually were 65 years or older, female individuals, and practiced in big cities. Patient comorbidity and morbidity were similar across strata of virtual care use. The mean (SD) number of ED visits was highest among patients whose physicians provided only in-person care (470.3 [1918.8] per 1000 patients) and was lowest among patients of physicians who provided more than 80% to less than 100% of care virtually (242.0 [800.3] per 1000 patients). After adjustment for patient characteristics, patients of physicians with more than 20% of visits delivered virtually had lower rates of ED visits compared with patients of physicians who provided more than 0% to 20% of care virtually (eg, &gt;80% to &lt;100% vs &gt;0%-20% virtual visits in big cities: relative rate, 0.77%; 95% CI, 0.74%-0.81%). This pattern was unchanged across all rurality of practice strata and after adjustment for 2019 ED visit rates. In urban areas, there was a gradient whereby patients of physicians providing the highest level of virtual care had the lowest ED visit rates.Conclusions and RelevanceFindings of this study show that patients of physicians who provided a higher percentage of virtual care did not have higher ED visit rates compared with patients of physicians who provided the lowest levels of virtual care. The findings refute the hypothesis that family physicians providing more care virtually during the pandemic resulted in higher ED use.

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Section: Discussionmentioning

confidence: 99%

Virtual Care and Emergency Department Use During the COVID-19 Pandemic Among Patients of Family Physicians in Ontario, Canada

Kiran

Green

Strauss³

et al. 2023

JAMA Netw Open

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“…Prior to COVID-19, several studies suggested virtual care could reduce emergency department and other hospital use, specifically for rural populations, 30 older populations, 31 and following a natural disaster. 32 Following COVID-19, a US study examining virtual care use and hospital visits for ambulatory-care sensitive conditions (ACSC) found that practices with high virtual care use had a small increase in ACSC visits compared to those with medium virtual care use, but differences disappeared when acute and chronic ACSC were evaluated separately. 11 Other studies suggest that virtual care use during the COVID-19 pandemic was higher among patients who were sicker, suggesting it supported care continuity when COVID-19 cases were high.…”

Section: Discussionmentioning

confidence: 99%

Are primary care virtual visits associated with higher emergency department use? A cross-sectional analysis from Ontario, Canada

Kiran

Green

Strauss

et al. 2022

Preprint

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Importance: The COVID-19 pandemic has resulted in increased use of virtual care, however, few studies have looked at the association between virtual primary care visits and other healthcare use. Objective: To determine whether there was an association between a high proportion of virtual visits in primary care and more emergency department visits Design: A cross-sectional study, using routinely collected data Setting: Ontario, Canada Participants: Ontario residents alive on March 31st 2021 and family physicians with at least 1 visit claim between February and October 2021. Exposure: Family physicians stratified by the percentage of total visits that were virtual (phone or video) between February and October 2021 Main outcome(s) and measure(s): We calculated the emergency department visit rate for each stratum of family physician virtual care use. We used multivariable logistic regression models to understand the relative rate of patient emergency department use after stratifying for rurality and adjusting first for patient characteristics and then the 2019 emergency department visit rate. Results: We analyzed data for 15,155 family physicians and 12,951,063 Ontarians attached to these physicians. The mean number of emergency department visits was highest among patients whose physicians provided only in-person care (470.3 ± 1918.8 per 1,000) and was lowest among physicians who provided >80 to <100% care virtually (242.0 ± 800.3 per 1,000). After adjustment for patient characteristics patients seen by physicians with >20% of visits delivered virtually had lower rates of emergency department visits compared to patients of physicians who provided >0%-20% virtually (e.g. >80 to <100% vs >0%-20% virtual visits in Big Cities, Relative Rate (RR) 0.80 [95%CI 0.76-0.83]). This trend held across all rurality strata and after adjustment for 2019 emergency department visit rates. In urban areas, there was a gradient whereby physicians providing the highest level of virtual care had the lowest emergency department visit rates. Conclusions and Relevance: Physicians who provided a high proportion of care virtually did not have higher emergency department visits than those who provided the lowest levels of virtual care. Our findings refute hypotheses that emergency department use is being driven by family physicians providing more care virtually.

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“…6 One study found that patient familiarity with telemedicine before a wildfire event resulted in a reduction in inpatient and emergency department use for ambulatory care sensitive conditions up to one year after a wildfire. 7 Telemedicine should be incorporated into health systems' climate preparedness plans to provide vulnerable patients, and providers, with alternative forms of care delivery during natural disasters.…”

Section: Opportunities In Medical Education and Beyondmentioning

confidence: 99%

Primary care needs to rise to the challenge of caring for patients during climate disasters

Azan

2023

BMJ

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Azan describes how this year's wildfires were an urgent reminder of how primary care needs to adapt to the threat climate change poses to health and health equity Alexander Azan internal medicine physician and climate health research fellowAs a primary care physician and climate health research fellow, I'm alarmed by how unprepared I was to counsel and care for my patients during an air quality emergency in New York City earlier this year. In June 2023, air pollution from wildfires raging in Canada moved into regions of the northeastern United States. As a result, communities in New York City were exposed to the worst air quality in the city's recorded history. 1

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Telemedicine Familiarity and Post-Disaster Utilization of Emergency and Hospital Services for Ambulatory Care Sensitive Conditions

Cited by 9 publications

References 23 publications

Virtual Care and Emergency Department Use During the COVID-19 Pandemic Among Patients of Family Physicians in Ontario, Canada

Virtual Care and Emergency Department Use During the COVID-19 Pandemic Among Patients of Family Physicians in Ontario, Canada

Are primary care virtual visits associated with higher emergency department use? A cross-sectional analysis from Ontario, Canada

Primary care needs to rise to the challenge of caring for patients during climate disasters

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