Disconnected: a survey of users and nonusers of telehealth and their use of primary care.

OBJECTIVE: The study sought to assess awareness, perceptions, and value of telehealth in primary care from the perspective of patients. MATERIALS AND METHODS: We conducted a cross-sectional, Web-based survey of adults with access to telehealth services who visited healthcare providers for any of the 20 most-commonly seen diagnoses during telehealth visits. Three groups were studied: registered users (RUs) of telehealth had completed a LiveHealth Online (a health plan telehealth service provider) visit, registered nonusers (RNUs) registered for LiveHealth Online but had not conducted a visit, and nonregistered nonusers (NRNUs) completed neither step. RESULTS: Of 32 831 patients invited, 3219 (9.8%) responded and 766 met eligibility criteria and completed surveys: 390 (51%) RUs, 117 (15%) RNUs, and 259 (34%) NRNUs. RUs were least likely to have a primary care usual source of care (65.6% vs 78.6% for RNUs vs 80.0% for NRNUs; P < .001). Nearly half (46.8%) of RUs were unable to get an appointment with their doctor, and 34.8% indicated that their doctor's office was closed. Among the 3 groups, RUs were most likely to be employed (89.5% vs 88.9% vs 82.2%; P = .007), have post-high school education (94.4% vs 93.2% vs 86.5%; P = .003), and live in urban areas (81.0% vs 69.2% vs 76.0%; P = .021). CONCLUSIONS: Telehealth users reported that they relied on live video for enhanced access and were less connected to primary care than nonusers were. Telehealth may expand service access but risks further fragmentation of care and undermining of the primary care function absent better coordination and information sharing with usual sources of patients' care.

Virtual Visits for Acute, Nonurgent Care: A Claims Analysis of Episode-Level Utilization.

BACKGROUND: Expansion of virtual health care-real-time video consultation with a physician via the Internet-will continue as use of mobile devices and patient demand for immediate, convenient access to care grow. OBJECTIVE: The objective of the study is to analyze the care provided and the cost of virtual visits over a 3-week episode compared with in-person visits to retail health clinics (RHC), urgent care centers (UCC), emergency departments (ED), or primary care physicians (PCP) for acute, nonurgent conditions. METHODS: A cross-sectional, retrospective analysis of claims from a large commercial health insurer was performed to compare care and cost of patients receiving care via virtual visits for a condition of interest (sinusitis, upper respiratory infection, urinary tract infection, conjunctivitis, bronchitis, pharyngitis, influenza, cough, dermatitis, digestive symptom, or ear pain) matched to those receiving care for similar conditions in other settings. An episode was defined as the index visit plus 3 weeks following. Patients were children and adults younger than 65 years of age without serious chronic conditions. Visits were classified according to the setting where the visit occurred. Care provided was assessed by follow-up outpatient visits, ED visits, or hospitalizations; laboratory tests or imaging performed; and antibiotic use after the initial visit. Episode costs included the cost of the initial visit, subsequent medical care, and pharmacy. RESULTS: A total of 59,945 visits were included in the analysis (4635 virtual visits and 55,310 nonvirtual visits). Virtual visit episodes had similar follow-up outpatient visit rates (28.09%) as PCP (28.10%, P=.99) and RHC visits (28.59%, P=.51). During the episode, lab rates for virtual visits (12.56%) were lower than in-person locations (RHC: 36.79%, P<.001; UCC: 39.01%, P<.001; ED: 53.15%, P<.001; PCP: 37.40%, P<.001), and imaging rates for virtual visits (6.62%) were typically lower than in-person locations (RHC: 5.97%, P=.11; UCC: 8.77%, P<.001; ED: 43.06%, P<.001; PCP: 11.26%, P<.001). RHC, UCC, ED, and PCP were estimated to be $36, $153, $1735, and $162 more expensive than virtual visit episodes, respectively, including medical and pharmacy costs. CONCLUSIONS: Virtual care appears to be a low-cost alternative to care administered in other settings with lower testing rates. The similar follow-up rate suggests adequate clinical resolution and that patients are not using virtual visits as a first step before seeking in-person care.

Comparing the use of intravenous antibiotics under the medical benefit with the use of oral antibiotics under the pharmacy benefit in treating skin and soft tissue infections.

PURPOSE: To assess differences in the simultaneous management of pharmacy and medical benefits by analyzing the health care utilization and costs associated with managed care patients who received oral linezolid as a pharmacy benefit or intravenous (IV) daptomycin or IV vancomycin as medical benefits for skin and soft tissue infections (SSTIs). METHODOLOGY: The first medical or pharmacy claim from 03/01/2007 to 03/01/2010 was defined as the index date. Patients 18-64 years of age, with an inpatient SSTI diagnosis and > or = 1 target antibiotic claim(s), were included. Follow-up was 45 days; hospitalizations, emergency room (ER) visits, outpatient medical services, prescription fills, and total health care costs were compared for the treatments using univariate generalized linear modeling (GLM) analyses. Total health care costs were compared with GLM multivariate analyses adjusting for baseline covariate values. RESULTS: Of the 8,905 patients included, 2,123 received linezolid, 5,503 vancomycin, and 1,279 daptomycin therapy; 14.4% of linezolid, 37.7% of vancomycin, and 22.8% of daptomycin patients were re-hospitalized (p < 0.001). A smaller proportion of linezolid patients (8.6%) required emergency services, versus 11.6% of vancomycin and 10.8% of daptomycin patients (p < 0.001). Multivariate analyses showed vancomycin costs to be significantly lower than daptomycin costs, -$5,425 (95% CI, -$1,535 to -$9,315), and a significantly higher mean cost difference for vancomycin, $11,182 (95% CI, $6,255 to $16,108), and daptomycin, $16,607 (95% CI, $9,426 to $23,788), versus linezolid. CONCLUSION: Patients treated with oral linezolid had fewer re-hospitalizations and emergency room visits and lower total costs compared with patients who received vancomycin or daptomycin therapy, suggesting that oral linezolid, which is covered under members' pharmacy benefits, may be more cost-effective than the two intravenous treatments for SSTIs.