Telehealth Video Nephrology Visits: Effect on Medication Prescriptions

Background: Telehealth utilization in nephrology care has greatly expanded in recent years, but telehealth's effect on clinical care interventions such as medication changes is unclear. Here we examine differences in number of medication changes resulting from ambulatory nephrology telehealth video vs. in-person visits. Methods: Visit data from one academic general nephrology clinic between 2020-2021 were extracted from the electronic medical record. A mixed effects model was used to assess the association between visit modality (telehealth video or in-person) and number of medication changes during the visit (new prescriptions, stopping medications, and changing doses), accounting for patient-level random effects and adjusting for age, sex, race, estimated glomerular filtration rate (eGFR), baseline number of medications, time since last visit, and visit type (new patient or follow-up). Results: Among 12502 visits with 3787 patients (mean age, 60; mean eGFR, 55 mL/min/1.73m2; 47% female; 59.5% on Medicare/Medicaid) and 106 providers, telehealth video visit modality was independently associated with 33% fewer medication changes (incidence rate ratio=0.67). Higher eGFR was also associated with fewer medication changes (IRR=0.90 per standard deviation increase), while higher number of baseline medications and longer time since last visit were associated with more changes (IRR=1.06 and IRR=1.05 per respective standard deviation increase). Conclusion: Telehealth video nephrology visits were independently associated with fewer medication changes compared to in-person visits. This suggests that telehealth visits are not interchangeable with in-person visits. Further research should establish best practices on how to incorporate telehealth in nephrology. Funding: NIDDK SupportFigure. Forest plot of model terms. IRRs for race, sex, first visit, and telehealth terms are given in comparison to reference values of "White," "Female," "Follow-up", and "In-person," respectively.