The impact of telephone-based telemedicine on unplanned hospital visits and mortality risk during the COVID-19 pandemic: a study from a middle-income country

Abstract

Background: Providing care via telemedicine was suggested worldwide during the COVID-19 pandemic. A new care model and service flow using telephone-based telemedicine (2T SAVE-COVID project) was established to provide care for patients at the Department of Medicine during the pandemic. This study aimed to investigate the clinical outcomes of patients after receiving care through telemedicine in the project. Methods: A retrospective cohort study was conducted to compare the clinical outcomes of patients receiving telemedicine compared to routine care at the outpatient clinics of the Medicine department from April 2020 to November 2021, including an original cohort (routine care: n = 54,032; telemedicine: n = 16,388) and a propensity score-matched cohort (n = 16,246 per group). Baseline and clinical characteristics, rates of unplanned visits and mortality outcomes were analyzed. Time prior to unplanned visits was calculated, and multivariate analysis was performed to identify predictors of unplanned visits. Findings: In the original cohort, the telemedicine group demonstrated a significantly higher incidence of unplanned outpatient visits (19.7% vs. 18.5%, p < 0.001). Conversely, in the matched cohort, the telemedicine group showed a lower rate of unplanned outpatient visits (19.4% vs. 59.3%, p < 0.001). Multivariate analysis confirmed that telemedicine was independently associated with a reduced risk of unplanned visits (adjusted HR: 0.69, 95% CI: 0.65 – 0.74, p < 0.001). However, other predictors with an increased incidence of unplanned visits included female patients, patients with chronic kidney disease stage 3 to 5, cancer and serum albumin levels below 4 g/dL. Additionally, telemedicine is associated with significantly lower mortality rates compared to routine care. Interpretation: Telephone-based telemedicine can be a viable alternative to routine care, offering comparable or improved outcomes in terms of a reduced rate of unplanned visits and lower mortality rates, particularly when combined with appropriate patient selection and monitoring strategies.