The Effect of Telemedicine on Preventive Medicine- A Case from Israel.

Background: Preventive medicine is one of the core elements of primary care physicians' (PCPs) work. This includes screening for cancer (such as Mammography and fecal occult blood test (FOBT) for breast and colon cancer) and also screening for chronic conditions (like bone density scans (DEXA scans) for osteoporosis). In recent years, especially since the COVID-19 pandemic, the use of telemedicine increased dramatically. This study aimed to identify the rate of preventative medicine referrals and performance in individuals who mostly had face-to-face encounters compared to those who mostly had remote encounters.

Methods: This retrospective cohort study is based on the electronic medical records of one healthcare maintenance organization (HMO) in Israel. We followed all individuals eligible for at least one of the screening tests in 2020 and 2021 and evaluated whether they received referrals to screening tests (mammography, FOBT, and DEXA scans) and performed them. Each individual was assigned to the face-to-face group (more than 60% of their encounters were face-to-face), the remote group (more than 60% of their encounters were remote), and the mixed group, which included the rest of the cohort.

Results: For mammographies and FOBT, the referral rates were lower in the face-to-face group compared to remote and mixed groups (mammographies: 27.3% vs. 29.8% and 32.9%, p-value < 0.001; FOBT: 55.6% vs. 60.3% and 58.7%, p-value < 0.001, respectively). However, for all three tests, the performance rates were the lowest in the remote group compared to face-to-face and mixed (for mammographies, 68.2% vs. 76.3% vs. 78.1; for FOBT, 44% vs. 56.8% vs. 54.3%; for DEXA 9.2% vs. 22.9% vs. 20.7%, respectively). A referral from the PCP increased the odds of performing the test for mammographies OR-1.55, 95% CI 1.52-1.58, and for FOBT OR-1.96, 95% CI 1.93-1.99.

Conclusion: Although PCPs referred their patients to screening tests in remote visits, the performance rate of individuals who mainly used telemedicine was lower than those who mostly had face-to-face visits. A referral for a screening test from the PCP increased the odds of performing it. Understanding individuals' health behaviors using telemedicine is crucial to maintaining adherence to preventing medicine.