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Tele-medicine preferred to in-person appointments — US study

DoctorNine out of 10 people who had a virtual visit with a doctor said it was more convenient than other ways of getting care, and it addressed their medical needs, found a Kaiser Permanente study.

Only four in 10 said they would prefer an in-person appointment, the researchers found.

"Patients had a very strong response to the convenience and quality of video visits – 84% said these visits improved the relationship with their provider," said Mary Reed, a research scientist at the Kaiser Permanente Northern California division of research, in Oakland.

Though some patients preferred in-person visits, Reed noted that telemedicine "isn't an either/or choice. A video visit might be just fine for some experiences. And some patients are more comfortable with in-person."

The report says millions of Americans have had virtual doctor visits over their phone, tablet or computer, researchers said some telemedicine services are virtual-only and don't have in-person facilities.

The current study looked at a hybrid system, however. Kaiser Permanente Northern California offers virtual visits to its primary care patients. Reed said patients were able to have a visit with their own physician about 70% of the time. If they couldn't see their own physician, the doctor they saw at least had access to their electronic health record.

The report says for the study, Reed and her colleagues surveyed nearly 1,300 patients who scheduled a video visit with a doctor in 2015 – 82% who scheduled a virtual visit completed it. The others communicated with their doctor another way – usually in-person or by phone.

One-third of patients who had a virtual appointment said it reduced the number of in-person doctor visits. More than half said it didn't change the amount of time they saw their doctor in the office.

According to the report, 70% of the study participants who scheduled a video visit did so because they weren't sure if they needed an in-person visit. Nearly half said they felt more comfortable discussing sensitive issues in a virtual visit, the findings showed. And 90% said they were confident in the quality of care they received during their telemedicine appointment, the researchers found.

The report says although most people had a positive experience with telemedicine, 21% said they were concerned about getting adequate treatment virtually. And 11% were concerned about the privacy of their medical information.

Kaiser Permanente's telemedicine programme is administered through its own mobile app. Reed said it's similar to a Skype or FaceTime video call.

Dr Rahul Sharma, chair of emergency medicine at New York-Presbyterian/Weill Cornell Medical Centre in New York City, called telemedicine a great complement to traditional health care. "It can save you time and you don't have to worry about transportation," he is quoted in the report as saying. "But there are definitely times when you need to see a doctor in-person."

Sharma said virtual visits are designed for minor health concerns, such as minor rashes, red eyes, sore throat or a sinus infection. A doctor's ability to do an exam is limited to areas he or she can see. If you have a rash somewhere you can't reach with the phone camera, a virtual visit probably won't work well, he noted.

If you think you're having a serious problem, it's best to head straight to the emergency room, he said in the report. Examples are if you're having problems like chest pain, slurred speech or difficulty breathing.

Real-time patient–provider video visits have the potential to engage patients by allowing them to access a clinical encounter without arranging transportation, taking time off from work, or spending time in a waiting room (1). Although millions of U.S. patients have used direct-to-consumer telemedicine services without in-person facilities, these services may lack integration with electronic health records and with clinicians from whom patients receive ongoing care (2). Evidence is limited from large-scale implementation of “house call” video visits integrated with ongoing health care delivery and providers in community primary care.

Mary E Reed; Jie Huang; Rahul Parikh; Andrea Millman; Dustin W Ballard; Irwin Barr; Craig Wargon

[link url=""]Health24 report[/link]
[link url=""]Annals of Internal Medicine abstract[/link]

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