New research published in the JAMA Network Open suggests primary care visits that take place via video or phone result in fewer imaging scan orders.

The COVID-19 pandemic has fueled telehealth as a primary way for physicians to offer patient care. As patients stay home to limit exposure to the virus, physician follow-up care can look different.

Using pre-pandemic data from more than 1.1 million patients, Kaiser Permanente researchers found that primary care doctors ordered imaging in roughly 59 percent of office visits versus 29 percent of virtual and 27 percent over the phone.

The study did not specify the reason behind the variance; however, the authors suggested patients who were more ill might have sought out in-person primary care.

Mary Reed, DrPH, a Kaiser Permanente research scientist, said, “It is possible that these differences in treatment might be driven by the types or seriousness of concerns that patients chose for each visit type, or by the degree to which physicians could assess the patient in each visit type. We need to explore these details further in future research.”

The study analyzed primary care appointments at Kaiser Permanente in Northern California between 2016 and midway through 2018; almost 2.2 million were evaluated. Video and telephone visits resulted in a lower number of medications prescribed (39 percent and 35 percent, respectively) compared to office-based visits, which were at 52 percent.

Overall, 25 percent of video visits required a follow-up appointment within a week. Telephone and in-person visits required follow-ups at 26 percent and 24.5 percent, respectively.

Emergency department visits or hospitalizations did not see a difference.

The study wrote, “In contrast to prior studies of direct-to-consumer telemedicine, we did not find evidence of over-ordering or over-prescribing among patients using telemedicine to visit their own primary care doctors. Video or telephone visits may be a convenient and safe way for patients to address some primary care needs without generating a substantial number of follow-up office visits or experiencing health events.”

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