Abstract
BACKGROUND: Asynchronous structured electronic visits (e-Visits) can offer efficient day-or-night care-seeking for some uncomplicated conditions when linked to their electronic health record. OBJECTIVE: Compare asynchronous e-Visit outcomes with scheduled telemedicine visits. DESIGN: Observational cohort study in an integrated delivery system during a COVID-19 pandemic restrictions on in-person visits. PARTICIPANTS: All 24,584 patients newly seeking primary care for urinary tract infection (UTI) or pink eye via e-Visit or telephone/video visit April 2020-March 2021. INTERVENTIONS: Asynchronous e-Visits. MAIN MEASURES: Antibiotic prescribing and follow-up care-seeking within 72 h or 7 days (office or ED visits, hospitalization) were examined using multivariable analyses. KEY RESULTS: Among 14,909 e-Visits, 6290 telephone visits, and 3385 video visits: 69.1% of UTI visits were e-Visits and 31.5% for pink eye were e-Visits. After adjustment, for UTI, 90.7% (95% CI: 90.2%-91.2%) of e-Visit patients received an antibiotic prescription and 13.9% (95% CI: 8.5%-9.5%) had a clinically related 7-day outpatient visit (vs. 60.7% [95% CI: 59.2%-62.1%] antibiotic prescribing for telephone and 57.3% [95% CI: 54.4%-60.2%] for video; 8.8% [95% CI: 8.0%-9.6%] return visits after telephone visit, and 9.0% [95% CI: 7.4%-10.6%] after video). For pink eye, 36.8% (95% CI: 33.7%-38.3%) of e-Visits received an antibiotic prescription and 13.9% (95% CI: 12.3%-15.6%) had an outpatient visit (vs. 42.6% [95% CI: 40.2%-45.1%] antibiotic prescribing for telephone and 39.9% [95% CI: 37.8%-41.9%] for video; 11.0% [95% CI: 9.4%-12.6%] return visits after telephone visit and 10.6% [95% CI: 9.4%-11.9%] after video). Clinically related emergency room visits were rare and not significantly different between visit types. CONCLUSIONS: Antibiotic prescribing varied, but return follow-up visits were comparable between telemedicine channels for UTI. Return rates for pink eye were 3% marginally higher after e-Visit than for scheduled telemedicine, without ED visit or hospitalization differences. Asynchronous care options for common primary care concerns may expand care access with comparable outcomes. Additional outreach may be needed to ensure access and awareness of e-Visits.