In-person versus telehealth video: A retrospective audit of medication prescriptions, orders, and patient instructions in ambulatory nephrology care

Introduction The COVID-19 pandemic greatly expanded the use of telehealth in nephrology, and telehealth remains a popular modality for kidney care. However, there are no consensus guidelines on the implementation of telehealth in ambulatory nephrology care. To examine this field further, we examined the association between clinic encounter modality (in-person versus telehealth) with provider actions to advance patient care plans in one academic nephrology practice. Methods Electronic health records from 26,170 telehealth video and 11,558 in-person encounters from January 2020 to December 2024 were analyzed. Mixed effects models were used to assess the association between encounter modality and medication prescription change rates, order rates, and patient instruction documentation frequency. Results Compared to in-person encounters, telehealth video visits served patients of younger age (60.4 years (SD = 18.1) vs. 66.7 (17.4), p < 0.001) and with less severe kidney disease (estimated glomerular filtration rate 51.9 ml/min/1.73 m 2 (SD = 30.2) vs. 46.1 ml/min/1.73 m 2 (26.6), p < 0.001). Accounting for encounter, patient, and provider characteristics, telehealth modality was independently associated with 23% fewer medication prescription changes (incidence rate ratio (IRR) = 0.77, 95% CI 0.74–0.80), 38% fewer orders (IRR = 0.62, 95% CI 0.57–0.68), and 84% lower odds of patient instructions documentation (odds ratio = 0.16, 95% CI 0.09–0.31) compared with in-person encounters. Conclusion These data suggest that providers use telehealth video and in-person encounters to advance patient care plans differently. Acknowledging these differences will be crucial to establish best practices for telehealth utilization in ambulatory nephrology care and assure ongoing high-quality care delivery.