In-person Follow-up Visit Attendance After Telemedicine Visits

Background: The coronavirus disease 2019 (COVID-19) pandemic led to a rapid increase in the use of telemedicine in health care. However, several elements of pediatric primary care visits including, vaccinations, screening tests and lab draws require direct patient contact. This often necessitates an in-person follow-up visit being scheduled after a completed telemedicine visit. This study investigated the in-person follow-up rate after telemedicine visits at East Carolina University (ECU) general pediatrics clinic. We also sought to find what, if any, patient and visit characteristics correlated with the non-completion of required vaccinations, screenings, or lab tests.

Methods: The study was approved by the Institutional Review Board at ECU. We conducted a retrospective cohort study of children who completed telemedicine visits in our clinic between April 1st and May 31st, 2020. Encounters that required a follow-up in-person visit were determined by manual chart review. Completion of required in-person follow-up was tracked through August 31st, 2020. Data analysis was completed in Stata 16.1 SE (College Station, TX: StataCorp, LP), and p<0.05 was considered statistically significant.

Results: Of 500 eligible encounters, 16% did not attend a recommended in-person follow-up. Among those who completed in-person follow-up, 19% did so more than seven days after their completed telemedicine visit. Comparisons between patient characteristics, visit types, and reason for the in-person follow-up were performed between patients who attended at least one in-person follow-up and those who did not. Results are summarized in Tables 1 and 2. There were no statistically significant difference in the reasons for the follow up visit among patients who did and did not attend, though the majority of non-attendance was for lab draws (29%) and examinations (21%). The main factor associated with lack of follow-up was patient age, which had a statistically significant difference in both bivariate and multivariable analysis. Infants had a higher follow-up rate when compared to children aged 1-5 (HR: 0.67; 95% CI: 0.53, 0.84; p=0.001). For health insurance coverage, encounter type, and reason for in-person follow-up, we found differences in the bivariate analysis that did not persist after multivariable adjustments.

Conclusion: Not all recommended in-person follow-ups were completed after pediatric primary care telemedicine visits. Understanding which patients face challenges in receiving all components of well and sick care while utilizing telemedicine is necessary for ensuring the health and well-being of children. While there were some statistically significant differences between patient populations who completed an in-person follow-up after having a telemedicine visit, those differences alone are likely unable to predict which patients are most at risk for non-completion. As telemedicine may continue playing an important role in the post-pandemic future, future work needs to be done to identify the barriers that exist for at-risk patients.