Patient-physician familiarity is just as important for virtual outpatient encounters as for in-person encounters: a retrospective cohort study

The COVID-19 pandemic substantially disrupted outpatient care delivery patterns, allowing us to evaluate whether outcomes after outpatient encounters (virtual or in-person) differed depending on patient-physician familiarity. Retrospective cohort study using data from linked healthcare databases in Alberta, Canada to capture all healthcare interactions for 4 million community-dwelling adults between March 2019 and February 2023. We defined "familiar physician" as any physician who had seen the patient in the preceding year, regardless of setting, and evaluated the associations between familiarity and subsequent healthcare utilization early and later in the pandemic after each patient's first outpatient encounter in each timeframe. Although patients having outpatient encounters (virtual or in-person) with unfamiliar physicians were younger and healthier (had fewer comorbidities, were less likely to be taking medications, and had less frequent healthcare contacts in the prior year), they had more ED visits, hospitalizations, or other outpatient encounters in the subsequent 7 days compared to patients whose outpatient encounter was with a familiar physician. The increased hazards associated with unfamiliar physician visits were similar whether outpatient encounters were virtual (40%, 77%, and 21% increases in the first 18 months of the pandemic and 28%, 71%, and 20% in the last 18 months) or in-person (40%, 143%, and 26% increases in the first 18 months of the pandemic; 34%, 131%, and 24% in the last 18 months). Outpatient encounters with unfamiliar physicians are associated with higher subsequent healthcare resource use than encounters with familiar physicians whether the encounters are virtual or in-person.