Associate Director for Value Based Care Boston Children's Hospital Boston Children's Hospital Boston, Massachusetts, United States
Background: Use of telehealth for urgent care increased during the COVID-19 pandemic. However, how telehealth affects urgent care quality, safety, and access to care has been little studied.
Objective: To compare urgent-care virtual visits (VVs) to in-person urgent care visits with respect to quality, safety, and equity of access.
Design/Methods: This observational study evaluated 5,731 VVs and 4,311 in-person urgent care visits from 3/17/20 through 12/17/20 and 16,906 in-person visits during the same time frame in 2019 at two academic primary care practices serving 22,000 majority non-white, publicly insured patients. To examine access we used parametric, non-parametric, and chi-square tests to detect demographic differences between cohorts. We assessed quality by reviewing rates of antimicrobial prescribing after VV and in-person visits. Our safety metric was the proportion of visits that were followed by an ED visit at our hospital within 72 hours. Poisson analyses were assessed for differences in rates of antibiotic prescribing and ED visits.
Results: Patients who had VVs were more likely to have limited English proficiency than those attending in-person visits, and all three groups had similar proportions of non-white and publicly insured patients, although the differences were statistically significant (table 1). Antibiotic prescribing rates for respiratory-tract infections were initially similar to those at in-person visits early in the pandemic but decreased over time and were overall significantly lower (p<0.001) (figure 1). Antibiotics for any condition were prescribed at a significantly lower rate at VVs than at either group of in-person visits (p<0.001) (figure 2). Patients with VVs had a lower rate of ED visits compared to those with in-person visits in 2019 (24.1 versus 29.0 per 1,000 VVs (p<0.01), but similar to those with in-person visits in 2020 (figure 3). 26.4% of ED visits after VVs resulted in hospital admission compared with 13.6% of in-person visits in 2019 and 18.4% of in-person visits in 2020 (NS). Conclusion(s): Access to telehealth urgent care has been similar to in-person visits and the quality of antibiotic prescribing has improved over time. While post-VV ED rate compares well to in-person visits, the acuity of VVs may differ from in-person visits and therefore bias the results. Continued tracking of access, quality, and safety of virtual visits will be essential to ensure utility and equity in telehealth post-pandemic.
Table 1 - Demographics of Virtual and In-Person Visit Cohorts
Figure 1 - Monthly Antibiotic Prescribing Rates for In-Person (2019 and 2020) and Virtual Urgent Care Visits with Acute Respiratory Tract Infection Diagnoses
Figure 2 - Monthly Antibiotic Prescribing Rates for In-Person (2019 and 2020) and Virtual Urgent Care Visits
Figure 3 - ED Visits Within 72 Hours of an Urgent Care (In-Person and Virtual) Visits, Per 1,000 Urgent Care Visits
Authors/Institutions: Eli Sprecher, Boston Children's Hospital, Boston, Massachusetts, United States; Kathleen Conroy, Boston Children's Hospital, Boston, Massachusetts, United States; Grace W. Chi, Boston Children's Hospital, Boston, Massachusetts, United States; Jennifer Krupa, Boston Children's Hospital, Boston, Massachusetts, United States; Amy Starmer, Boston Children's Hospital, Boston, Massachusetts, United States