The impact of remote and telemedicine visits on family physicians workload

Shlomo Vinker, Avivit Golan Cohen, Ilan Green, Eugene Merzon, Ariel Yehuda Israel

Keywords: telemedicine, work load, correspondence, face-to-face

Background:
In the COVID-19 pandemic, number of face-to-face visits to family physicians reduced dramatically. In Leumit Health Services (LHS) about two-thirds of visits became remote, using correspondence, telephone, or video consultations. Later on, patients resumed face-to-face visits while continuing to use remote modalities, non-face-to-face visits stayed at about 40%.

Research questions:
To evaluate the interchangeability between face-to-face visits and remote visits, we calculated the AADT (Accumulated Annual Duration of Time) of visits and the impact of the incorporation of remote medicine on workload.

Method:
A cross-sectional study based on the electronic medical records of all patients of LHS who had at least one visit to their primary care physician both in 2020 and 2021 (N=562,758 patients).
Patients had been classified into A) Remote medicine utilizers (RMU) – patients who used video or telephone visits. B) Correspondence utilizers (CU) – patients who used correspondence without using video or telephone. And C) Non-Remote utilizers (NRU) – patients who had only face-to-face visits. For each patient we calculated AADT, and we calculated the average AADT in each category of patients. We excluded all COVID-19 patients in 2020-2021 from the analysis.

Results:
The AADT increased by 56% among the 45,200 patients who were NRU and become RMU in 2021. AADT increased by 38% among the 38,300 patients who were CU and become RMU in 2021. The ADDT was reduced by 25% among patients who were RMU and become NRU in 2021. Patients who were in the same category in 2020 and 2021 stayed almost at the same ADDT.
The AADT of the entire cohort had a net increase of 5% in 2021 in comparison to 2020.

Conclusions:
The new remote visit modalities were additive visits and increased workload. Stakeholders should be acknowledged that this extra time spent with the patients increases costs and burn-out, yet without any proven outcome benefits.

Points for discussion:
remote vs. face-to-face

how to evaluate quality and effectiveness of remote medicine

lessons learned from COVID tele-consultations