Evaluating Clinical Outcomes and Physician Adoption of Telemedicine for Chronic Disease Management: Population-Based Retrospective Cohort Study

Background: In recent years, the use and impact of telemedicine for providing health care services to patients has increased, reducing the requirement for physical, in-person encounters. Objective: This study aimed to compare the use of telemedicine for outpatient visits versus in-person visits across different medical specialties; assess its association with clinical outcomes; and examine the influence of patient and physician characteristics on telemedicine use in a large, tertiary, teaching hospital. Methods: The study cohort consisted of adult patients who attended outpatient clinics in five medical fields (psychiatry, endocrinology, nephrology, hemato-oncology, and gastroenterology) in 2019 and survived until the beginning of 2020. Telemedicine use during the period of 2019-2021 was the main exposure of interest. The primary outcomes were emergency department (ED) referrals and hospitalizations. The analysis used multivariate mixed models and subgroup analysis by patient demographic characteristics, chronic disease medical fields, and physicians' characteristics. Results: The cohort included 32,445 patients. In 2019, a total of 99.6% (82,668/83,000) of visits were in person, and by 2020-2021, a total of 22.6% (10,850/48,120) of patients had used telemedicine. Telemedicine patients were slightly older (standardized mean difference=0.281; P<.001), with a higher comorbidity burden than in-person patients or patients without visits (standardized mean difference=0.328; P<.001). Presurge telemedicine users had higher rates of ED referrals (incidence rate ratio [IRR] 1.15, 95% CI 1.09-1.21) and hospitalizations (IRR 1.14, 95% CI 1.08-1.20) than in-person visit users. These ratios remained stable during the surge (IRR 1.1, 95% CI 1.06-1.16 and IRR 1.12, 95% CI 1.05-1.19, respectively), with no evidence of worsening outcomes for telemedicine users relative to in-person care. Health care providers with higher telemedicine use had reduced rates of ED referrals (IRR 0.85, 95% CI 0.79-0.91) and hospitalizations (IRR 0.78, 95% CI 0.72-0.84) than providers with lower telemedicine use. Conclusions: This study provides insights into telemedicine use patterns and their association with clinical outcomes in chronic disease management. Our findings suggest that the increase in telemedicine use was not associated with a rise in ED referrals or hospitalizations when compared to in-person visits. It highlights the importance of health care providers' perspectives and use of remote visits. Telemedicine should be tailored to individual patient-physician needs, considering the nature of the patient's disease.