Disclosures: Ryan E. Alano, MD, MPH: No financial relationships or conflicts of interest

Objective: The COVID pandemic has accelerated adoption of telemedicine. While this may maintain patient access to healthcare, the question of how it affects medical decision making remains. The aim of this quality improvement project was to compare the rates of therapy referrals between telemedicine and in-person visits. Specifically, we examined new evaluations of low back pain in a Physical Medicine and Rehabilitation clinic and how often patients were referred to outpatient therapies, including physical therapy, kinesiotherapy, chiropractic care, and acupuncture

Design: Quality improvementSetting : Outpatient PM&R practiceParticipants : Male and female Veterans

Interventions: None

Main Outcome Measures: Referral rates to therapy seen between telemedicine (telephone and video visits) and in-person visits

Results: Initially, 1332 patients with a history of low back pain were selected. Only new evaluations were included in analyses (N = 552). Of those receiving a referral, 56% (n = 309) received PT, 8% (n = 46) received acupuncture, 7% (n = 42) received chiropractic care, and 12% (n = 64) received KT. Overall, 79% of in-person visits, 59% of telephone visits, and 27% of video visits received at least one referral.Conclusions: Telemedicine has changed the landscape of healthcare. While it maintains access, especially during the COVID pandemic, questions remain regarding quality of care and medical decision making. This project demonstrated more patients were referred directly to therapies after in-person visits, compared to telemedicine. Patients seen via telemedicine may have undergone additional testing, such as imaging or other diagnostics, prior to referral. This may potentially be associated with and underscore the importance of performing physical exams during face-to-face visits, compared to limited examinations during telemedicine. Findings highlight the possibility that providers may rely more on further diagnostic testing after virtual visits, as a result of the limited physical exam. Further studies are needed to truly assess the efficacy of telemedicine.

Level of Evidence: Level V

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PM&R Meeting Abstracts - https://pmrjabstracts.org/abstract/difference-in-referral-patterns-to-therapy-between-telemedicine-and-in-person-visits-among-patients-with-low-back-pain/