Telehealth in primary care: Meeting patient and family needs

ABSTRACT

Background: Telehealth is a novel way to provide care to patients and families and may be especiallyimportant for families with transportation challenges. The COVID-19 pandemic with social distancingrequirements further accelerated the need for the utilization and expansion of telehealth services. Objective:To evaluate the feasibility of rapidly scaling primary-care telehealth and its impact on families' location of careand associated transportation costs. Methods: A retrospective study was conducted at a large, urban,academic primary care center consisting of 6 primary care sites, with approximately 85% of patients coveredby Medicaid. In February 2020, just prior to the COVID-19 pandemic, telehealth was launched for routinefollow-up of chronic medical conditions (e.g., ADHD, asthma) and acute complaints (e.g., rashes) two half-daysper week. Due to COVID-19, rapid escalation of telehealth was necessary and during these telehealth visits,families were asked the location of care they would have chosen if telehealth was not available (in-personprimary care, Emergency Department (ED), Urgent Care (UC), or opt for no care). Miles saved (measured bydistance from family residence zip code to the hospital main campus where the ED, UC, and most primary care sites are located) and cost saved (as measured by federal reimbursement amounts for mileage) weredetermined from demographic information in the electronic health record. Results: Five physicians trained anadditional 16 clinicians over 2 weeks, providing the ability to expand telehealth to six days per week. FromFebruary-March 2020, 245 unique telehealth encounters were completed. Providers asked 60% (n=147) offamilies where they would have sought in-person care if telehealth was not available, with the largest percent(68.7% (n= 101)) indicating a primary care visit. In addition, 14.2% (n= 21) of families reported intent to visit theED, 4.8% (n=7) an UC and 12.2% (n=18) would have opted for no care. Regarding savings related to distance toan alternative location of care, families saved an average of 16 miles ($9.30) for an in-person primary care visit,13 miles ($7.19) for an ED visit, and 11.4 miles ($6.23) for an urgent care visit. Families who would have optedfor no care lived the farthest, with an average 21 miles. A substantial percent of families (19%;n=28) reportedthat they would have sought more costly care options (ED or UC). Conclusion: Rapid scaling of primary carebased telehealth was feasible serving a mostly publically insured population. The majority of families reportedthat without telehealth, they would have sought in-person visits, but those who lived farthest would not havesought care. Telehealth appears to be a cost saving alternative for families and the medical system. Next stepsinclude a trial of social risk and mental health screening during telehealth visits.