An After-Hours Telemedicine Urgent Care Service May Not Improve Access to Care for Underserved Populations

• Published in: Telemedicine journal and e-health Vol. 30; no. 10; p. 2573
• Main Authors: Brill, Jonathan, Heymann, Anthony David, Zacay, Galia
• Format: Journal Article
• Language: English
• Published: United States 01-10-2024
• Subjects: Adolescent; Adult; After-Hours Care - statistics & numerical data; Aged; Child; Child, Preschool; Cross-Sectional Studies; Emergency Service, Hospital - statistics & numerical data; Female; Health Services Accessibility - statistics & numerical data; Humans; Infant; Male; Medically Underserved Area; Middle Aged; Socioeconomic Factors; Telemedicine - statistics & numerical data; Vulnerable Populations - statistics & numerical data; Young Adult; telemedicine; health care disparities; remote emergency care; after-hours telehealth
• ISSN: 1556-3669
• DOI: 10.1089/tmj.2023.0714

After-hours telemedicine services for emergency care are thought to offer a solution for patients who live at a distance from traditional face-to-face emergency services. This study evaluates such a service in a Health Maintenance Organization, focusing on the differences between central and peripheral populations.
In this cross-sectional database study, we collected data regarding the encounter and patient characteristics, including prescriptions, referrals for further evaluation in a traditional emergency department (ED), and the distance from a traditional ED. Other outcome measures included health care utilization after the encounter such as primary care physician (PCP) encounters, additional telemedicine encounters, ED visits, and hospitalization.
In total, 45,411 patient visits were analyzed. Medication was prescribed in 25% of the encounters, and a referral to an ED was given in 22%. In total, 17.7% of the patients visited an ED within 24 h of the index encounter. In total, 64.8% of patients visited a PCP in the following 30 days. No further care was needed in 32.4% of the encounters. In multivariable logistic regression, the odds of using the service were lower for low socio-economic status groups and inhabitants of the periphery than the central areas. A weak reverse correlation was observed in Jewish sectors regarding distance from traditional ED, whereas no correlation was found in the Arab sector.
It is commonly believed that telemedicine overcomes geographical barriers. The results of this research do not support this hypothesis.