SRFP023: Clinical Effectiveness of Video Visits for Low Back Pain and Headache in a Primary Care Setting

Elyse Gonzales, BS; Doris Chen; Marcy Winget, PhD; Jonathan Shaw, MD, MS; Ian Nelligan, MD, MPH

Abstract

Context: The COVID-19 pandemic has catalyzed the use of video visits in primary care. It is estimated that 73% of primary care visits can be effectively completed via video. However, there are no studies that demonstrate clinical effectiveness of video visits for specific chief complaints. Objective: To evaluate the clinical effectiveness of video visits compared to in-person visits for 2 common primary care chief complaints. Study design: Retrospective chart review. Dataset: Manual chart review of in-person visits from August-October 2019 and video visits from August-October 2020 from our institution’s outpatient urgent care clinic (Stanford Express Care), restricted to 2 of the most common presenting chief complaints (CCs): low back pain and headache. Population studied: Patients who presented to a Stanford Express Care clinic with one of the aforementioned CCs. Outcome measures: Frequency of clinician recommendation for an urgent office or ED visit after the initial patient visit and frequency of follow-up visits within a 3-week period were used to assess clinical effectiveness of the visit. A visit is considered clinically effective when a clinician does not recommend an urgent office or ED visit after the initial patient visit and the patient does not have in-person follow-up visits within 3 weeks of the initial visit. Frequency of referrals placed and diagnostic imaging studies ordered during the initial patient visit were also measured. Results: Video visits for low back pain were less likely to be effectively assessed compared to in-person visits [74% (37/50) vs 82% (54/66), chi-square p=0.3]. During video visits for low back pain clinicians placed fewer referrals [24% (12/50) vs 36% (24/66), chi-square p=0.2] and ordered fewer diagnostic imaging studies [12% (6/50) vs 21% (14/66), chi-square p=0.2]. Video visits for headache were more likely to be effectively assessed compared to in-person visits [86% (43/50) vs 74% (37/50), chi-square p=0.1]. During video visits for headache, clinicians placed fewer referrals [14% (7/50) vs 22% (11/50), (chi-square p=0.3 ) and ordered fewer diagnostic imaging studies [2% (1/50) vs 18% (9/50), chi-square p=0.007]. Conclusions: For low back pain and headache, video visits were not significantly less likely than in-person visits to be effective. There was a statistically significant decrease in diagnostic imaging studies ordered during video visits for headaches.
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Jack Westfall
jwestfall@aafp.org 11/21/2021

very interesting study on telehealth effectiveness. Great poster and abstract. Thanks for sharing at NAPCRG

Gillian Bartlett
gillian.bartlett@health.missouri.edu 11/21/2021

Very interesting project - I wonder how the decrease in imaging might relate to decreased low value care? Would love to see you explore that more explicitly.

William R. Phillips
wphllps@uw.edu 11/21/2021

Great. Very important research question. You picked two of the most challenging clinical conditions for focus of the study. I'm not sure they belong together. Almost no clinical intervention changes the outcome of low back pain patients, so it's not surprising you did not document a difference here. The best way to avoid unnecessary or inappropriate testing such as imaging is to avoid unnecessary referral to specialist care, which these telehealth visits or any intermediate visits effectively do. Thanks for sharing your work here at NAPCRG.

Diane Harper
harperdi@med.umich.edu 11/22/2021

Thank you for sharing your work with NAPCRG!

Andy Pasternak
avpiv711@sbcglobal.net 11/26/2021

Love to see some of these studies coming out about video visits. Very well done

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