Comparison of healthcare utilization between telemedicine and standard care: a propensity-score matched cohort study among individuals with chronic psychotic disorders in Ontario, Canada

Background — Telemedicine adoption has grown significantly due to the COVID-19 pandemic, however it remains unclear what the impact of widespread telemedicine use is on healthcare utilization among individuals with psychosis.

Objectives — To investigate the impact of telemedicine use on changes in healthcare utilization among patients with chronic psychotic disorders (CPDs).

Study Design — We conducted a population-based, retrospective propensity-matched cohort study using healthcare administrative data in Ontario, Canada. Patients were included if they had at least one ambulatory visit between March 14, 2020 and September 30, 2020 and a CPD diagnosis any time prior to March 14, 2020. Telemedicine users (2+ virtual visits after March 14, 2020) were propensity score-matched 1:1 with standard care users (minimum of 1 in-person or virtual ambulatory visit and maximum of 1 virtual visit after March 14, 2020) based on several baseline characteristics. Monthly use of various healthcare services was compared between the two groups during 12 months before to 3 months after their index in-person or virtual ambulatory visit after March 14, 2020 using generalized estimating equations (e.g., hospitalizations, ED visits and outpatient physician visits). The slope of change over the study period (i.e., rate ratio) as well as a ratio of slopes, were calculated for both telemedicine and standard care groups for each outcome.

Study Results — A total of 18,333 pairs of telemedicine and standard care patients were identified after matching (60.8% male, mean(SD) age 45.4(16.3) years). There was a significantly greater decline across time in the telemedicine group compared to the standard care group for ED visits due to any psychiatric conditions (ratio of slopes for telemedicine vs standard care (95% CI), 0.98 (0.98-0.99)). However, declines in primary care visit rates (ratio of slopes for telemedicine vs standard care (1.01 (1.01-1.02)), mental health outpatient visits with primary care (1.03 (1.03-1.04)), and all-cause outpatient visits with primary care (1.01 (1.01-1.02)), were steeper among the standard care group than telemedicine group.

Conclusions — Overall, patients with CPDs appeared to benefit from telemedicine as evidenced by increased outpatient healthcare utilization and reductions in ED visits due to psychiatric conditions. This suggests that telemedicine may have allowed this patient group to have better access and continuity of care during the initial waves of the pandemic.