TOPLINE:

Virtual primary care visits were associated with a 49% higher risk for emergency department (ED) visits in children aged 3 months to 2 years and 19% higher risk in those aged 2-17 years than in-person visits. Among 2,608,503 children studied, virtual visits comprised 27.6% of sick visits.

METHODOLOGY:

• Population-based cohort study analyzed 2,608,503 unique children (132,352 aged < 3 months; 282,720 aged 3 months to < 2 years; 2,193,431 aged 2-17 years) who had primary care sick visits between September 2020 and March 2024 in Ontario, Canada.
• The primary outcome measure included ED visits within 3 days of the primary care visit, while secondary outcomes encompassed ED visits leading to hospitalization or death, high-acuity ED visits, and low-acuity ED visits.
• Analysis utilized age-stratified multivariable logistic generalized estimating equation models, adjusting for sociodemographic, clinical, and health system factors while clustering patients within physicians.
• Researchers randomly selected one visit per child during the study period, categorizing children by age groups (< 3 months, 3 months to < 2 years, and 2-17 years).

TAKEAWAY:

• Virtual visits comprised 719,119 (27.6%) of all sick visits, with children aged 3 months to < 2 years showing increased adjusted risk for subsequent ED visits when seen virtually vs in person (4.4% vs 3.5%; adjusted risk ratio [ARR], 1.49; 95% CI, 1.41-1.57).
• Children aged 2-17 years demonstrated higher ED visit risk following virtual care (2.2% vs 2.4%; ARR, 1.19; 95% CI, 1.15-1.24), particularly for low-acuity visits (ARR, 1.27; 95% CI, 1.19-1.36).
• Virtual visits were associated with lower risk for ED visits leading to hospitalization or death in children aged ≥ 3 months (aged 3 months to < 2 years: ARR, 0.59; 95% CI, 0.49-0.72; aged 2-17 years: ARR, 0.62; 95% CI, 0.56-0.69).
• Children aged < 3 months showed no significant difference in subsequent ED visits between virtual and in-person care (2.9% vs 2.8%; ARR, 1.12; 95% CI, 0.99-1.27).

IN PRACTICE:

“While virtual care may sufficiently and safely triage visits that are unlikely to need admission or result in death, health system administrators and clinicians should consider the unique needs of children when developing policies and infrastructure around virtual care and when determining the modality of clinical encounters,” the authors of the study wrote.

SOURCE:

This study was led by Gabrielle Freire, MDCM, MHSc, The Hospital for Sick Children in Toronto, Ontario, Canada. It was published online on December 18 in JAMA Network Open.

LIMITATIONS:

According to the authors, when defining the cohort, the selection of one random sick episode per child may have affected results as children with increased healthcare utilization may differ from those with lower utilization. The assignment of in-person status to episodes with multiple visits could have underestimated effect sizes. Additionally, unmeasured confounding related to patient or practitioner preferences for virtual or in-person care over time, including SARS-CoV-2 anxiety and personal protective equipment availability, may have influenced the findings.

DISCLOSURES:

This study was funded by Canadian Institute for Health Research (CIHR) Grant UIP-178845. Freire disclosed receiving grants from CIHR during the conduct of the study and grants from CIHR and interning for Translating Emergency Knowledge for Kids outside the submitted work. Additional disclosures are noted in the original article.

This article was created using several editorial tools, including AI, as part of the process. Human editors reviewed this content before publication.