Comparing Outcomes of Musculoskeletal Radiographs from In-Person and Telemedicine Primary Care Cohorts, April 2019-June 2021

Purpose: Musculoskeletal conditions are a common reason for primary care visits, and they are being increasingly addressed at televisits. We therefore examined outcomes of musculoskeletal radiographs ordered at in-person and telemedicine primary care visits, which have implications for patient care and the economic impact of telemedicine.Metbods: We performed a retrospective cohort study of musculoskeletal radiograph orders placed April 1, 2019-March 31, 2021 at a major academic health system. Radiology reports were classified as normal or abnormal based on the radiologist's impression. Findings were compared using c(2) tests.Results: The main outcome was radiographic abnormalities. A secondary outcome was the effect of social determinants of health and medical comorbidities on telemedicine utilization. A total of 1580 radiographs were reviewed. Compared with televisits occurring after onset of the SARS-Cov2-19 pandemic, radiographs ordered at in-person visits had higher odds of being abnormal (OR 2.51, 95% CI 1.33-4.75; P 1/4 .004). When comparing radiographic outcomes at in-person visits before and after the pandemic's onset, those ordered afterward had higher odds of being abnormal (OR 1.88, 95% CI 1.30- 2.71; P < .001). Social determinants of health and medical comorbidities were not associated with tele-medicine utilization.Conclusions: After the onset of the SARS-Cov2-19 pandemic, radiographs ordered at in-person visits had higher odds of being abnormal compared with televisits. These findings indicate that prudence should be applied to ordering musculoskeletal radiographs in telemedicine encounters. ( J Am Board Fam Med 2023;36:739-745.)