Patient Characteristics Associated With Choosing a Telemedicine Visit vs Office Visit With the Same Primary Care Clinicians

Abstract

Importance: Video or telephone telemedicine can offer patients access to a clinician without arranging for transportation or spending time in a waiting room, but little is known about patient characteristics associated with choosing between telemedicine or office visits.

Objective: To examine patient characteristics associated with choosing a telemedicine visit vs office visit with the same primary care clinicians.

Design, setting, and participants: This cross-sectional study included data from 1 131 722 patients who scheduled a primary care appointment through the Kaiser Permanente Northern California patient portal between January 1, 2016, and May 31, 2018. All completed primary care appointments booked via the patient portal were identified. Only index visits without any other clinical visits within 7 days were included to define a relatively distinct patient-initiated care-seeking episode. Visits for routine physical, which are not telemedicine-eligible, were excluded. Data were analyzed from July 1, 2018, to December 31, 2019.

Main outcomes and measures: Patient choice between an office, video, or telephone visit. Relative risk ratios (RRRs) for patient sociodemographic characteristics (age, sex, race/ethnicity, neighborhood socioeconomic status, language preference), technology access (neighborhood residential internet, mobile portal use), visiting the patient's own personal primary care clinician, and in-person visit barriers (travel-time, parking, cost-sharing), associated with choice of video or telephone telemedicine (vs office visit).

Results: Of 2 178 440 patient-scheduled primary care visits scheduled by 1 131 722 patients, 86% were scheduled as office visits and 14% as telemedicine visits, with 7% of the telemedicine visits by video. Choosing telemedicine was statistically significantly associated with patient sociodemographic characteristics. For example, patients aged 65 years and over were less likely than patients aged 18 to 44 years to choose telemedicine (RRR, 0.24; 95% CI, 0.22-0.26 for video visit; RRR 0.55; 95% CI, 0.54-0.57 for telephone visit). Choosing telemedicine was also statistically significantly associated with technology access (patients living in a neighborhood with high rates of residential internet access were more likely to choose a video visit than patients whose neighborhoods had low internet access: RRR, 1.10; 95% CI, 1.06-1.14); as well as in-person visit barriers (patients whose clinic had a paid parking structure were more likely to choose a telemedicine visit than patients whose facility had free parking: RRR, 1.70; 95% CI, 1.41-2.05 for video visit; and RRR, 1.73, 95% CI, 1.61-1.86 for telephone visit).

Conclusions and relevance: In this cross-sectional study, patients usually chose an in-person visit when scheduling an appointment online through the portal. Telemedicine may offer the potential to reach vulnerable patient groups and improve access for patients with transportation, parking, or cost barriers to clinic visits.

Figure 1.. Patient-Scheduled Primary Care Video Visits, by Quarter

Patient self-scheduling capability first added to the Kaiser Permanente Northern California patient portal in 2016.

Figure 2.. Relative Risk Ratios (RRRs) of Patient Sociodemographic Characteristics and Telemedicine Visit Choice

A, Video visit vs clinic visit comparison. B, Telephone visit vs clinic visit comparison. SES indicates socioeconomic status.

Figure 3.. Relative Risk Ratios (RRRs) for Barriers to In-Person Visits and Telemedicine Visit Choice

A, Video visit vs clinic visit comparison. B, Telephone visit vs clinic visit comparison.

Figure 4.. Relative Risk Ratios (RRRs) for Patient Technology Access and Personal Clinician With Telemedicine Visit Choice

A, Video visit vs clinic visit comparison. B, Telephone visit vs clinic visit comparison.