Healthcare Utilization Differences Among Primary Care Patients Using Telemedicine in the Veterans Health Administration: a Retrospective Cohort Study

Amy M.J. O’Shea, Kailey Mulligan, Paige Carlson, Bjarni Haraldsson, Matthew R. Augustine, Peter J. Kaboli, Stephanie L. Shimada

Research output: Contribution to journalArticlepeer-review


Background: The COVID-19 pandemic encouraged telemedicine expansion. Research regarding follow-up healthcare utilization and primary care (PC) telemedicine is lacking. Objective: To evaluate whether healthcare utilization differed across PC populations using telemedicine. Design: Retrospective observational cohort study using administrative data from veterans with minimally one PC visit before the COVID-19 pandemic (March 1, 2019–February 28, 2020) and after in-person restrictions were lifted (October 1, 2020–September 30, 2021). Participants: All veterans receiving VHA PC services during study period. Main Measures: Veterans’ exposure to telemedicine was categorized as (1) in-person only, (2) telephone telemedicine (≥ 1 telephone visit with or without in-person visits), or (3) video telemedicine (≥ 1 video visit with or without telephone and/or in-person visits). Healthcare utilization 7 days after index PC visit were compared. Generalized estimating equations estimated odds ratios for telephone or video telemedicine versus in-person only use adjusted for patient characteristics (e.g., age, gender, race, residential rurality, ethnicity), area deprivation index, comorbidity risk, and intermediate PC visits within the follow-up window. Key Results: Over the 2-year study, 3.4 million veterans had 12.9 million PC visits, where 1.7 million (50.7%), 1.0 million (30.3%), and 649,936 (19.0%) veterans were categorized as in-person only, telephone telemedicine, or video telemedicine. Compared to in-person only users, video telemedicine users experienced higher rates per 1000 patients of emergent care (15.1 vs 11.2; p < 0.001) and inpatient admissions (4.2 vs 3.3; p < 0.001). In adjusted analyses, video versus in-person only users experienced greater odds of emergent care (OR [95% CI]:1.18 [1.16, 1.19]) inpatient (OR [95% CI]: 1.29 [1.25, 1.32]), and ambulatory care sensitive condition admission (OR [95% CI]: 1.30 [1.27, 1.34]). Conclusions: Telemedicine potentially in combination with in-person care was associated with higher follow-up healthcare utilization rates compared to in-person only PC. Factors contributing to utilization differences between groups need further evaluation.

Original languageEnglish
Pages (from-to)109-117
Number of pages9
JournalJournal of General Internal Medicine
Issue numberSuppl 1
StatePublished - Feb 2024


  • COVID-19
  • internet access
  • primary care
  • telemedicine
  • veterans


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