Abstract
IMPORTANCE: Asynchronous structured electronic visits (e-visits) in which online systems ask defined questions about prespecified conditions are an emerging modality for providing highly convenient outpatient care. Scant information exists on their use and outcomes. OBJECTIVES: To (1) compare the percentage of initial visits made via e-visits with telephone, video, or office appointments for 4 common outpatient conditions; (2) compare rates of related follow-up visits within 7 days among visit modalities; and (3) identify patient characteristics associated with e-visit and follow-up visit use. DESIGN, SETTING, AND PARTICIPANTS: Cross-sectional analysis of e-visits and telephone, video, and office visits made in Kaiser Permanente Northern California, where The Permanente Medical Group provides care for 4.6 million patients. The study population was defined based on initial outpatient visits (e-visits, telephone or video appointment visits, or physician's office visits) by persons aged 18 years and older between January 1 and December 31, 2024, for 4 prespecified conditions. Data from 2023 and 2025 were used to analyze selected baseline variables. MAIN OUTCOMES AND MEASURES: The numbers of e-visits and other types of visits for 4 diagnoses (urinary tract infection [UTI], seasonal allergies, acne, and international travel advice) in adults from January through December 2024 identified in electronic health record data and, secondarily, telephone advice calls identified for UTI alone. Initial visits were those without previous visits or medications for the condition in the prior 365 days. Analyses of the rates of follow-up visits used modified Poisson regression and adjusted for patient characteristics. To simplify interpretation, adjusted percentages of different types of visits and adjusted rates of follow-up visits were calculated via marginal standardization. RESULTS: In 73 560 initial visits (86% by females; 41% by participants aged 18-39 years), e-visits were used in 58% (27 268 of 47 264) of UTI, 24% (3718 of 15 646) of seasonal allergy, 24% (1532 of 6426) of acne, and 56% (2377 of 4224) of international travel visits. E-visit use was highest among patients aged 18 to 29 years or 30 to 39 years for most conditions. After e-visits, follow-up visits for the same diagnosis within 7 days were uncommon: for UTI, the adjusted rate was 2.48%; for seasonal allergy, 6.45%; for acne, 2.11%; and for international travel, 0.12%. Follow-up visit rates after e-visits were lower than after other visit modalities for UTI, higher for seasonal allergy, and similar for acne and travel. For UTI e-visits, the risk of follow-up visits was higher among patients aged older than 65 years (adjusted relative risk, 2.50; 95% CI, 1.60-3.92), Hispanic patients, Asian patients, or those who were Medicaid insured. For seasonal allergy and acne, the risk of follow-up visits did not vary with patient characteristics. CONCLUSIONS AND RELEVANCE: In this cross-sectional study, high percentages of patients selected asynchronous physician-managed e-visits for common outpatient conditions in a setting where other visit types were available. Both e-visits and other visit types attained high rates of resolution without follow-up within 7 days.