• Dana R Sax, Mamata V Kene, Jie Huang, Anjali Gopalan, and Mary E Reed.
• Department of Emergency Medicine, Kaiser Permanente Oakland Medical Center, and Kaiser Permanente Northern California Division of Research, Pleasanton, CA, USA. dana.r.sax@kp.org.
• J Gen Intern Med. 2024 Oct 1; 39 (13): 244624532446-2453.

BackgroundTelemedicine use expanded greatly during the COVID-19 pandemic. More data is needed to understand how this shift may impact other venues of acute care delivery.ObjectiveWe evaluate the association of visit modality (telephone, video, or office) and downstream emergency department (ED) and hospital visits among primary care visits for acute, time-sensitive conditions.DesignObservational study of patient-scheduled primary care telemedicine and office visits for acute conditions (cardiac, gastrointestinal, neurologic, musculoskeletal, and head and neck) in a large, integrated healthcare delivery system.ParticipantsAdults with a new self-booked primary care appointment for an eligible acute condition from January 1, 2022, to December 31, 2022 (with no primary care, ED, or hospital visits in prior 30 days).InterventionsVisit modality, including office, video, or telephone.Main MeasuresSeven-day ED and hospital utilization, adjusted for patient and visit characteristics.Key ResultsAmong 258,958 primary care visits by 239,240 adult patients, 57.7% were telemedicine visits; of these, 72.4% were telephone and 27.6% were video. Telephone visits were the timeliest, with over 70% of visits scheduled within 1 day of booking. Rates of 7-day ED utilization were low, and varied by condition group, with cardiac visits having the highest rates (4.8%) and musculoskeletal visits having the lowest (0.8%). There was less than a 1% absolute difference in ED use by visit modality for all condition types; however, telephone visits were associated with slightly higher rates than video visits. The 7-day hospitalization rate was less than 1% and observed between visit type differences varied by clinical condition.ConclusionsAmong office, telephone, and video visits in primary care for potentially high-risk, time-sensitive conditions, downstream ED and hospital use were uncommon. ED utilization was lower for video visits than telephone visits, although telephone visits were timelier and may offer a safe and accessible option for acute care.© 2024. The Author(s), under exclusive licence to Society of General Internal Medicine.

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