Dive Brief:
- Rates of completion for high-risk diagnostic tests and referrals were lower when ordered during a telehealth visit compared with an in-person appointment, according to a study published in JAMA Network Open.
- For telehealth orders, 43% were completed during the designated time frame compared with 58% of tests and referrals requested during in-person appointments, and 57% of those ordered without any visit at all.
- Failure to get tests or complete referrals is a leading cause of diagnostic errors, and safety risks can be a particular concern in primary care due to the large number of potential diagnoses, researchers said.
Dive Insight:
Telehealth use, once a more niche method of delivering healthcare, soared during the COVID-19 pandemic as providers quickly pivoted to virtual visits to avoid unnecessary in-person contact.
Regulators loosened rules for the digital service, including permitting Medicare telehealth visits outside of rural areas or through telephone calls. Bipartisan lawmakers have demonstrated support for making telehealth flexibilities permanent, some of which expire at the end of next year.
Though telehealth use has fallen from pandemic-era highs, virtual care is still elevated and particularly popular for mental healthcare. Virtual care can also offer more convenient and accessible services for patients, especially for people in rural areas who may have to travel longer distances to reach an in-person provider.
The latest study, which included test and referral orders for more than 4,000 patients, found low completion rates across visit types, highlighting the need for more investments in test tracking and outreach to patients, especially for people who rely on telehealth care.
“One potential mechanism to explain this may be the lack of systems in place to help patients complete test and referral orders. During in-person visits, members of the support staff team sometimes help patients schedule their tests at checkout; however, this support is absent during telehealth visits,” researchers wrote.
The study used data for three types of high-risk tests: colonoscopy referrals, dermatology referrals for suspicious skin lesions and cardiac stress tests. Study authors looked to see whether orders were complete within 365 days for colonoscopies, 90 days for dermatology referrals and 45 days for cardiac stress tests.
Patients with telehealth visits were less likely to complete colonoscopies on time, but the study didn’t find statistically significant differences for urgent dermatology referrals or stress test orders.
Colonoscopies are a more invasive procedure that requires more preparation for the patient, which could explain why they’re less likely to complete these referrals, researchers wrote.
