The Executive Suite: Are telehealth visits for pediatric primary care associated with higher rates of health care utilization?

More than 12 million children rely on telehealth each year in the United States, according to a National Health Statistics report. Despite this, studies supporting telehealth as an effective vehicle for health care in pediatric populations have been relatively scarce since its emergence during the COVID-19 pandemic. Now, researchers looked to determine whether pediatric primary care telehealth visits were associated with more medication prescribing, imaging and laboratory ordering, in-person follow-up visits, emergency department (ED) visits or hospitalizations, compared with in-person visits. Research out of Kaiser Permanente Northern California (KPNC), published in the Journal of the American Medical Association (JAMA) Health forum, determined that primary health care systems that utilize telehealth appear to be meet the pediatric primary care needs of patients, although they should not serve as a universal substitute for in-person visits.

“In this cohort study, primary care pediatric telemedicine was associated with less medication prescribing and laboratory ordering compared with in-person visits across most areas of clinical concern,” the authors of the study explained. “Based on our results, health care systems and private pediatrics practices seeking to initiate or broaden their pediatric telemedicine programs should expect that primary pediatric care delivered by telephone or video may be associated with modest increases in in-person follow-up visits and slightly higher ED utilization, but negligible differences in downstream hospitalizations compared with traditional in-person visits.”

The cohort study looked at all patients younger than 18 years old who had scheduled primary care appointments with a pediatrician from January 1 to December 31, 2022, in the KPNC health care system. Of 782,596 total pediatric appointments among 438,638 distinct patients, 332,153 pediatric primary care appointments were conducted with telehealth.

Researchers found a higher rate of medication prescribing in in-person visits, at 39.8%, compared with 29.5% of video visits or 27.3% of telephone visits. Similarly, there was more laboratory ordering for in-person visits, at 24.6%, compared with 7.8% of video visits or 8.5% of telephone visits.

In-person visits also saw more frequent imaging ordering, at 8.5% of visits, compared with 4.0% of video visits, and 3.5% of telephone visits. However, in-person follow-ups were seen less often for index visits that occurred in-person, at 4.3%, compared to video or telephone visits, at 14.4% and 15.1%, respectively. ED visits following in-person visits were also lower, occurring following 1.75% of visits, compared with video visits, at 2.04%, or telephone visits, at an even 2.00%. The study found no statistically significant difference in the 7-day rate of hospitalizations.

The authors of the study note that 49.2% and 47.3% of the in-person visits were scheduled after an index video or telephone call, respectively. According to the authors, this finding likely supports a role for telehealth in identifying patients who require prompt, in-person evaluation.

The study evaluated a comprehensive, large and integrated health care system. Results suggest that pediatric primary care visits conducted over video or telephone calls were associated with less overall physician prescribing and ordering, as well as modest increases in subsequent short-term in-person visits and slight increases in downstream ED encounters, with no statistically significant differences in hospitalizations. Although the authors of the study still do not recommend telehealth as a universal substitute for in-person primary care visits, these findings demonstrate the considerable growth of telehealth since its rapid emergence in 2020. It could now be a viable alternative to in-person visits for pediatric primary care.