# Hospitalization after Initial Telemedicine Versus in-Person Consultation for Outpatients with Respiratory or Digestive Diseases: A Retrospective Cohort Study

## TL;DR

This study found that patients who had their first medical consultation via telemedicine were more likely to be hospitalized within a month compared to those who had in-person consultations.

## Contribution

The study provides new evidence on the association between initial telemedicine consultations and increased hospitalization rates in patients with respiratory or digestive diseases.

## Key findings

- Patients with initial telemedicine consultations had a 1.0% hospitalization rate within a month, compared to 0.5% for in-person consultations.
- The odds ratio for hospitalization was 2.61 for telemedicine versus in-person consultations.
- The association remained significant after adjusting for confounding factors using propensity score matching and multilevel logistic regression.

## Abstract

We compared the proportion of hospitalizations in patients who received initial telemedicine consultations and in those who received in-person consultations.

We used the DeSC database, a large administrative claims database for Japan, from April 2020 to November 2022. In this retrospective cohort study, we identified outpatients with respiratory or digestive diseases. The exposure group comprised patients who received an initial telemedicine consultation through the use of telephones and other telecommunication devices. The control group comprised patients who underwent an initial in-person consultation. The outcome measure was hospitalization within 1 month of the index date. Propensity score matching and multilevel logistic regression were performed, with patients at the subject level and medical institutions at the cluster level. A total of 3,026,260 eligible patients were identified. The index date for each patient was defined as the day when the patient was diagnosed with respiratory or digestive diseases at the initial consultation. Respiratory and digestive diseases were defined according to the International Classification of Diseases, 10th Revision codes.

The proportions of hospitalization within 1 month of the index date were 1.0% and 0.5% in the telemedicine and in-person consultation groups, respectively (odds ratio, 2.61; 95% confidence interval, 1.64-4.14; p < 0.001).

Initial telemedicine consultation was significantly associated with an increase in hospitalization when compared with initial in-person consultation.