Is Virtual Primary Care better than office-based Primary Care?

Summary: Yes, for most people, most of the time.?

Recently I reported on the Hidden benefits of Primary Care, and described that those benefits also occur when primary care is delivered virtually. But you may ask how we know that all these benefits also occur when primary care is delivered virtually.

Many still believe that in order to deliver effective primary care, doctors (and other healthcare providers) must meet and interact with their patients in the office setting. However, clinical experience over the past decade, and more recent published research demonstrate that this is not true. When doctors connect with their patients virtually, they create relationships of trust and caring that are the foundation for effective primary care. Indeed, multiple studies have demonstrated the effectiveness of virtual primary care:

• Virtual primary care improves adherence and follow-up [JAMA]
• Post-discharge visit completions are 22.5% greater with virtual care [JGenIntMed]
• Virtual primary care doctors are less likely to overprescribe [JAMA]
• Virtual care works for seniors too [AARP]?

A common misconception is that doctors have to meet a patient in person and perform a physical examination in order to develop a trusted, caring relationship. It is counterintuitive, but it turns out that when a doctor’s only contact with their patient is via video, the doctor actually pays increased attention to their patient, hyper-focusing on details of their patient’s appearance and attire, mannerisms, affect, mood, voice, verbal tone, intonation, facial and eye movements, skin color and complexion, posture, and motor movements.

Other benefits of virtual primary care include?

• Accessibility: People can reach their doctor from anywhere, without the challenges of transportation to the office
• Convenience: Virtual care is available at any time from your home, via any mobile, tablet or web browser
• Cost-effectiveness: It's less expensive without all the staff, equipment, and costs of a brick and mortar office
• Focus on preventive health: Doctors evaluate a wide array of health risks, and provide screening tests for high cholesterol, high blood pressure, diabetes, thyroid function, STIs, colorectal cancer, and breast cancer, and provide reminders and referrals for needed specialty services, such as retinal examinations for patients with diabetes.
• Safety: There's no exposure to other sick people in the office, which is especially important? during cold and flu season (or during a pandemic).?

Patient experience

People who have experienced virtual primary care visits on HealthTap tell us how much they like it: The reviews are outstanding, and ratings of virtual primary care visits consistently average more than 4.9 out of 5 stars.?

Doctor experience

Virtual healthcare is a rewarding solution for doctors too. They appreciate the autonomy of managing their own virtual practice. They love the freedom from additional administrative or clerical tasks, concerns about billing and payment, managing staff, and credentialing, and all the challenges of an office-based practice. Most of all, they love how virtual consultations provide them undistracted time to focus on their patients. Doctors using the HealthTap app give us a net promoter score (NPS) of 80!??

Medical establishment perspective

The American Medical Association (AMA) has concluded that Virtual Primary Care is effective:???

The AMA is focused on helping confront the increasing chronic disease burden, especially preventing or managing diabetes, blood pressure, and substance use, and helping increase patient care and physician satisfaction by leveraging telehealth technology as an asset, not a burden.

and the Federation of State Medical Boards (FSMB) endorses virtual care:

When utilized appropriately, telemedicine technologies can enhance connection between patients and physicians, and reduce inequities in the delivery of care. Telemedicine technology can facilitate patient examinations and permit diagnosis, if acceptable under the standard of care. Telemedicine technologies also enable remote patient monitoring and permit physicians to obtain medical histories, give medical advice and counseling, and prescribe medication and other treatments.

Of course, people with serious conditions who need more intensive management, parenteral therapy, and office-based procedures should not receive all their care virtually. But most people, most of the time, really just need a connection with a doctor they trust who can give them needed ongoing care, preventive health services, and lifestyle/healthy living guidance and advice. All these things lead to the measured benefits of primary care, and they are all more easily, more effectively, and more efficiently delivered virtually.??

Conclusion

What we need is more universal access to Virtual Primary Care, so everyone can have a primary care doctor they trust.?

References

• Comparison of Quality Performance Measures for Patients Receiving In-Person vs Telemedicine Primary Care in a Large Integrated Health System. JAMA Netw Open?
• Treatment and Follow-up Care Associated With Patient-Scheduled Primary Care Telemedicine and In-Person Visits in a Large Integrated Health System. JAMA Netw Open
• Association of Telemedicine with Primary Care Appointment Access After Hospital Discharge. Journal of General Internal Medicine
• An Updated Look at Telehealth Use Among U.S. Adults Age 50-Plus AARP
• The Most Important Telemedicine Patient Satisfaction Dimension: Patient-Centered Care Telemedicine and e-Health
• Myths and misconceptions about virtual primary health care KevinMD
• Telemedicine is not medicine KevinMD
• America's physicians supporting telehealth AMA
• The Appropriate Use Of Telemedicine Technologies In The Practice Of Medicine? FSMB