P1025 - Telehealth in Primary Care: Meeting Patient and Family Needs

Background: Telehealth is a novel way to provide care to patients and families and may be especially important for families with transportation challenges. The COVID-19 pandemic with social distancing requirements further accelerated the need for the utilization and expansion of telehealth services.

Objective: To evaluate the feasibility of rapidly scaling primary-care telehealth and its impact on families’ location of care and associated transportation costs.

Methods: A retrospective study was conducted at a large, urban, academic primary care center consisting of 6 primary care sites, with approximately 85% of patients covered by Medicaid. In February 2020, just prior to the COVID-19 pandemic, telehealth was launched for routine follow-up of chronic medical conditions (e.g., ADHD, asthma) and acute complaints (e.g., rashes) two half-days per week. Due to COVID-19, rapid escalation of telehealth was necessary and during these telehealth visits, families were asked the location of care they would have chosen if telehealth was not available (in-person primary care, Emergency Department (ED), Urgent Care (UC), or opt for no care). Miles saved (measured by distance from family residence zip code to the hospital main campus where the ED, UC, and most primary care sites are located) and cost saved (as measured by federal reimbursement amounts for mileage) were determined from demographic information in the electronic health record.

Results: Five physicians trained an additional 16 clinicians over 2 weeks, providing the ability to expand telehealth to six days per week. From February-March 2020, 245 unique telehealth encounters were completed. Providers asked 60% (n=147) of families where they would have sought in-person care if telehealth was not available, with the largest percent (68.7% (n= 101)) indicating a primary care visit. In addition, 14.2% (n= 21) of families reported intent to visit the ED, 4.8% (n=7) an UC and 12.2% (n=18) would have opted for no care. Regarding savings related to distance to an alternative location of care, families saved an average of 16 miles ($9.30) for an in-person primary care visit, 13 miles ($7.19) for an ED visit, and 11.4 miles ($6.23) for an urgent care visit. Families who would have opted for no care lived the farthest, with an average 21 miles. A substantial percent of families (19%; n=28) reported that they would have sought more costly care options (ED or UC).

Conclusion: Rapid scaling of primary care based telehealth was feasible serving a mostly publically insured population. The majority of families reported that without telehealth, they would have sought in-person visits, but those who lived farthest would not have sought care. Telehealth appears to be a cost saving alternative for families and the medical system. Next steps include a trial of social risk and mental health screening during telehealth visits.