14 October 2022

Telehealth vs. In-Person

Welcome back. Have you ever used telehealth (aka telemedicine)? At the height of the pandemic, these virtual visits for remote healthcare were estimated to have increased 20-fold in the US. The number of outpatient visits has since returned to pre-pandemic levels, but the number of telehealth visits is still high.

Using telehealth when you probably shouldn’t opt for an outpatient visit (from www.premierhealth.com/your-health/articles/health-topics/telehealth-visit-your-doctor-without-leaving-home).
If you’re considering or on the fence about telehealth, I thought you might be interested in a recently published study that compared telehealth and in-person diagnoses. The study assessed the agreement between diagnoses from video telehealth consultations for new clinical problems with the same patients’ in-person diagnoses within 90-days for the same clinical problems. (Spoiler alert: telehealth came out pretty well).

Study Design
The diagnostic study was conducted by a team of Mayo Clinic researchers at Mayo Clinic locations in Minnesota, Arizona, Florida, Iowa and Wisconsin between 24 March and 24 June 2020.

In all, 2,393 patients (median age 53 years, 58% female) were included. Each underwent a video telehealth consultation followed by an in-person outpatient visit for the same clinical problem in the same specialty within a 90-day window.

The telehealth provisional diagnosis was the diagnosis offered by the telehealth clinician at the end of the visit, taking into account the referral indication, chief concern, any diagnostic records, history acquisition and video exam. The reference standard diagnosis was the diagnosis offered by the in-person clinician at the end of the outpatient visit, taking into account the in-person history acquisition and physical exam, results of any diagnostic testing, and any information available in the electronic medical record up to the date of the in-person visit.

Each patient’s case (i.e., both telehealth and in-person) was independently reviewed by two third- or fourth-year medical students. Where the two reviewers’ assessments disagreed, the principal researcher reviewed the case in consultation with a specialist from the applicable clinical area. If the reviewer determined that the provisional diagnosis disagreed with the reference standard diagnosis, the reviewer further assessed whether the disagreement had the potential for morbidity or mortality and whether there was any actual morbidity or mortality.

Study Findings
The researchers rated the provisional diagnosis established over the telehealth visit to be in agreement with the in-person diagnosis in 87% of the cases, with no significant effect of sex, Mayo Clinic site or patient location.

Concordance estimates (modified from Table 2 of jamanetwork.com/journals/jamanetworkopen/fullarticle/2795871).
Diagnostic agreement (by International Statistical Classification of Diseases and Related Health Problems, 10th Revision) ranged from 65% for diseases of the ear and mastoid process to 97% for neoplasms (tumors). Diagnostic agreement by medical specialty ranged from 77% for otorhinolaryngology (ear, nose and throat) to 96% for psychiatry. Specialty care was significantly more likely than primary care to be in agreement.

Video telemedicine diagnostic concordance by International Statistical Classification of Diseases and Related Health Problems, Tenth Revision Diagnosis Chapter (modified from Fig. 3 of jamanetwork.com/journals/jamanetworkopen/fullarticle/2795871).
Wrap Up
The researchers conclude that video telehealth visits may be good adjuncts to in-person care. They caution, however, that primary care video telehealth programs designed to accommodate new patients or new clinical problems might benefit from timely in-person follow-up for patients suspected to have diseases typically confirmed by physical examination, neurological testing or pathology.

I’ve never had cause to use telehealth, but given the study results, I wouldn’t hesitate if the need arose. What do you think? Thanks for stopping by.

US Dept of Health and Human Services website on telehealth: telehealth.hhs.gov/
Mayo Clinic website on telehealth: www.mayoclinic.org/healthy-lifestyle/consumer-health/in-depth/telehealth/art-20044878
Peterson Center on Healthcare and Kaiser Family Foundation website on outpatient use of telehealth: www.healthsystemtracker.org/brief/outpatient-telehealth-use-soared-early-in-the-covid-19-pandemic-but-has-since-receded/
Study of video telehealth vs. in-person diagnostic concordance in JAMA Network: jamanetwork.com/journals/jamanetworkopen/fullarticle/2795871
Announcement of study on EurekAlert! website: www.eurekalert.org/news-releases/963465

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