Evaluating Clinical Outcomes and Physician Adoption of Telemedicine for Chronic Disease Management: Population-Based Retrospective Cohort Study

Abstract

Background: In recent years, the use and impact of telemedicine for providing health care services to patients has increased, reducing the requirement for physical, in-person encounters. Objective: This study aimed to compare the use of telemedicine for outpatient visits versus in-person visits across different medical specialties; assess its association with clinical outcomes; and examine the influence of patient and physician characteristics on telemedicine use in a large, tertiary, teaching hospital. Methods: The study cohort consisted of adult patients who attended outpatient clinics in five medical fields (psychiatry, endocrinology, nephrology, hemato-oncology, and gastroenterology) in 2019 and survived until the beginning of 2020. Telemedicine use during the period of 2019-2021 was the main exposure of interest. The primary outcomes were emergency department (ED) referrals and hospitalizations. The analysis used multivariate mixed models and subgroup analysis by patient demographic characteristics, chronic disease medical fields, and physicians’ characteristics. Results: The cohort included 32,445 patients. In 2019, a total of 99.6% (82,668/83,000) of visits were in person, and by 2020-2021, a total of 22.6% (10,850/48,120) of patients had used telemedicine. Telemedicine patients were slightly older (standardized mean difference=0.281; P