Family Medicine

High telehealth primary care use modestly increases visit volume without raising hospital use or spending

This national Medicare cohort compared beneficiaries in primary care practices with high vs low telehealth E&M use after COVID-19 expansion. High-telehealth practices had fewer in-person E&M visits but a small net increase in total E&M visits per patient per year. Emergency department visits, including preventable ED visits, increased slightly, but the absolute change per patient was small. There were no significant differences in hospitalizations, ambulatory care–sensitive admissions, or total health care spending. For family physicians, greater telehealth use appeared clinically safe and largely cost-neutral at the system level. 1

Virtual annual visits miss more screening opportunities than in-person visits

This EHR-based cohort matched over 22,000 in-person and virtual annual visits across 87 primary care practices. Both high- and low-value tests were less likely to be ordered and completed at virtual than at in-person annual visits. High-value tests had about 14% lower ordering and 13% lower completion with virtual visits, relative to in-person baselines. Low-value tests dropped even more, and point-of-care labs showed the largest decreases at virtual visits. Telemedicine annuals may reduce low-value testing but also risk underuse of recommended screening without deliberate follow-up workflows. 2

Centralized pharmacist deprescribing support showed no significant added benefit for older adults on opioids or benzodiazepines

This cluster randomized trial enrolled 2075 adults 65 years or older with long-term opioid or benzodiazepine use in primary care. Intervention clinics received centralized consultant pharmacist chart reviews and taper recommendations; control clinics received usual care. Both groups reduced opioid and benzodiazepine doses over one year, with no statistically significant between-group differences in dose changes. Medication discontinuation and fall outcomes also did not differ significantly between intervention and control clinics. Providing remote recommendations alone may be insufficient; effective deprescribing likely requires more embedded, relationship-based approaches. 3

Risk-adapted "Smart PSA" guidelines increased screening and aggressive prostate cancer detection in high-risk FQHC settings

A 15-month trial in six urban clinics serving high-risk, largely Black communities implemented risk-adapted PSA screening guidance. PSA screening following primary care encounters rose from 18.7 to 33.0 per 100 patients, a substantial absolute increase. Guideline-consistent behavior included larger screening increases among younger Black men and earlier repeat testing after borderline PSA results. Biopsy rates rose, total prostate cancer incidence increased 2.7-fold, and cancers beyond grade group 1 also increased. Intensified, risk-adapted screening improved detection in a previously underscreened population but may eventually require safeguards against overdiagnosis. 4