The impact of Telephone-based Telemedicine on unplanned hospital visits and mortality risk during the COVID-19 pandemic: A study from a middle-income country

Background: Providing care via telemedicine has been suggested worldwide during the COVID-19 pandemic. A new care model and service flow using telephone-based telemedicine (2T SAVE-COVID project) was established to provide care for patients at the Department of Medicine during the pandemic. This study aimed to investigate the clinical outcomes of patients after receiving care through telemedicine in the project. Methods: A retrospective cohort study was conducted to compare clinical outcomes of patients receiving telemedicine compared to routine care at the outpatient clinics from April 2020 to November 2021. All-cause mortality was obtained from the hospital database and the civil registration. The outcomes were the incidence of unplanned visits and mortality rate compared between groups. Findings: 16,395 patients received telemedicine under the 2T SAVE-COVID project and 32,380 patients were matched in the routine care group. The 2T group had higher age, the number of medications used and dementia diagnosis. The 2T group demonstrated a significantly lower risk of experiencing unplanned hospital visits with adjusted HR 0.22 (95%CI 0.21-0.23, p value <0.001). The patients in the geriatric clinic receiving telemedicine also had lower risk of unplanned hospital visits with adjusted HR 0.23 (95%CI 0.20-0.27). Interpretation: The use of telemedicine showed benefits in reducing unplanned hospital visits for older patients during the COVID-19 pandemic. This successful strategy of implementing telephone-based telemedicine for carefully chosen groups of patients could potentially expand to other service areas in resource-limited settings. Funding: Faculty of Medicine Siriraj Hospital, Mahidol University, Grant Number (IO) R016531029.