DOES ACCESS TO TELEHEALTH IN PRIMARY CARE AFFECT PRIMARY CARE UTILIZATION IN A LARGE, PUBLIC HEALTHCARE SYSTEM?

ABSTRACT

BACKGROUND: Telehealth services may improve access to care by removing certain barriers to care. But, health systems and payors may be hesitant to provide or cover telehealth at the same rate as in-person services in part due to concerns around potential to increase overall healthcare utilization. During the coronavirus disease pandemic, many regulatory restrictions on telehealth were paused, allowing more widespread usage of telehealth. We sought to investigate whether patients engaged in telehealth had increased primary care (PC) utilization relative to those not engaged in telehealth. METHODS: We conducted an observational study of electronic health record data for patients with PC visits from July 1, 2020 to June 30, 2021 at 23 adult PC clinics at New York City Health + Hospitals, the nation's largest public healthcare system. This period represents when local COVID cases were past initial peak and telehealth visits were available to patients electively instead of preferentially. The primary outcome was the average number of annual completed PC visits per patient. We collected patient age, sex, race/ethnicity, language, insurance, and number of Elixhauser comorbidities and compared them between groups using χ2 tests. Then, we stratified patients by quintiles of comorbidity count and compared the average number of completed PC visits per patient between telehealth users and non-users using two-sided Welch's ttests. RESULTS: There were 569,724 visits by 225,147 patients. Of these patients, 133,830 (59.4%) were telehealth users. Compared to telehealth non-users, telehealth users were more likely to be older, female, Asian, Medicare beneficiaries, and have more comorbidities and less likely to be Black, commercially insured, or uninsured (p<0.001). The average (SD) number of PC visits were 2.9 (1.7) for telehealth users and 1.9 (1.3) for non-users. Compared to telehealth non-users, telehealth users had 1more PC visit per patient regardless of comorbidity count (Table;p<0.001). Among telehealth users, the average proportion of visits that were conducted via telehealth was 0.68 (0.28). CONCLUSIONS: Availability of telehealth may increase PC utilization in safety-net clinics. Differences in utilization may relate to decreases in barriers to care, lower efficacy of telehealth, or differences in propensity to engage in care not accounted for by comorbidity count. More research on outcomes, costs of care, patient and clinician experiences is essential to better inform policymakers' and payors' decisions around coverage of telehealth services.