Telehealth, in-person visits comparable in quality: study

Telehealth visits for primary care can be comparable in quality to in-person visits, suggesting remote testing and screenings are valuable tools to augment patient care.

The finding follows a study of more than 500,000 patients across 200 outpatient care sites in Pennsylvania and Maryland who either had exposure to telemedicine or only had in-person visits between March 1, 2020, and November 30, 2021.

The report examines the care quality performance of telemedicine and in-person patient groups for 16 Health Care Effectiveness Data and Information Set measures selected across five domains of primary care: cardiovascular, diabetes, prevention and wellness, behavioral health and pulmonary. 

In 13 of 16 medication, testing and counseling-based measures, exposure to telemedicine was associated with similar or significantly better quality performance. The study was published in JAMA Network Open.

Higher quality scores for telemedicine prove that remote care is worth the cost of reimbursement just like in-office care, said Dr. Derek Baughman, an author of the study and medical director at Barksdale Air Force Base and Medical Clinic. 

“This isn’t just one or two measures, it’s showing that for most of the measures, we’re providing at least comparable quality,” he said. “We’re not making these measures worse.”

For all counseling and testing-based measures—including vaccinations, cardiovascular disease and diabetes testing and screenings for depression and cancer—telehealth care encounters were more likely to meet HEDIS quality benchmarks than solely in-person patients. 

The results are examples of clinical domains where telemedicine could be used as an alternative to in-office care, Baughman said. Prioritizing telehealth visits for chronic disease management and preventive care could lead to better quality outcomes as well as more affordable care.

“It’s not that we’re going to eliminate the need for an in-office encounter. We’re just saying when we have a recession, inflation, and people with limited resources, if you can balance the scales in overall spending, you can still provide a comparable quality of that care in certain scenarios,” Baughman said. 

When it comes to medication-based HEDIS measures such as cardiovascular disease patients receiving antiplatelets or patients with upper respiratory infections receiving antibioltics, patients with office-only visits typically had better quality performance, though only three of the five measures had significant differences between in-person and telemedicine patients. 

The data in this report should spur more research to find out why telehealth allows for higher quality in some instances, said Krista Drobac, executive director of the Alliance for Connected Care.

“Maybe it’s because if you can more easily check in with your practitioner without having to get childcare and go through traffic and parking and all of that, you might be more apt to manage your disease on an ongoing basis,” Drobac said. 

Future studies should also include patient perception of telehealth, and more demographics, as this report was overwhelmingly composed of white patients who only had in-person visits, she said. 

“We’ve always said that telemedicine is medicine,” Drobac said. “It’s just a different modality and so the quality should be comparable.”