Multivariate Analysis of Physicians’

Practicing Behaviors in an
Urgent Care Telemedicine Intervention
S48: mHealth and Telemedicine

Songzi Liu, Barbara Edson, Robert

Gianforcaro, Saif Khairat
University of North Carolina at Chapel Hill
Background
Knowledge of telemedicine physicians barely exists.
Literature:
§ Current telemedicine research:
§ Patients‘ Satisfaction, Clinical Effectiveness (in certain specialties),
Management Outcomes. 1
§ Prescription outcomes in traditional, face to face settings:
§ Inter-physician variations in prescription are prominent.
§ Male physicians tend to be high-prescriber.2

Gaps in Knowledge:
§ Who’re the telemedicine physicians? How do they prescribe online?
Learning Objectives
§ Understand the telemedicine physicians population.
§ Identify variations in physicians’ prescription outcomes.
§ Discuss ways to improve physicians’ prescribing behaviors
in telemedicine delivery.
Virtual Urgent Care (VUC) at
UNC Healthcare
§ Serves Residents of North Carolina
§ 24/7 availability
§ $49 flat fee per consultation

§ Treats acute illness—sore throat, fever, stomach pain, rashes, etc.

§ Offers phone and video consultation powered by a third party
telemedicine platform.
§ Can be accessed from web browser and smartphone APP.
Methods: Overview
§ Sample size: 1,217
§ Subjects: 25 board-certified physicians and 763 unique
patients.
§ Time frame: Feb. 8th to Nov.29th 2018 (First 10 month of
operation.)

§ The statistical analyses and models were generated using R

Statistical Packages; The data visualizations were generated
with Tableau Desktop.
Methods: Statistical Modelling
§ Descriptive and Multivariate Analysis
§ Two outcome variables
• Prescription Binary (Y/N, %)
• Multivariate Logistic Regression
• Pearson Chi-Squared Test
• Prescription Count (0,1,2,3,4,5,6)
• Poisson Regression
• Kruskal-Wallis test
Results: Telemedicine Providers
Demographics
Years of Practice
Providers by Gender

6,
24%
10,
38%
16, 19,
62% 76%

> 10 Years of Practice

Female Male < 10 Years of Practice

§ The 16 Male Physicians contributed § The 19 Physicians with more than

71.49% of total visits. 10 years of practice contributed
84.72% of total visits.
 Results: Telemedicine Providers
Demographics

PHYSICIANS BY SPECIALTY

Family Medicine,
9, 36%

Emergency Primary Care

Medicine, 6, 24% 76%

Internal Medicine,
8, 32%
Pediatrics, 2, 8%

§ The 19 (76%) Primary Care Physicians contributed 68.45% of total visits.

Results: Visits at a Glance

E-visits by
Medium
VIDEO
12%

PHONE
88%

PHONE VIDEO

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Results: Visits at a Glance
Visits by
Day of week
Sun. Mon. Tu. Wed.
Th. Fri. Sat.

Sat. Sun.
14% 13%

Mon.
Fri. 14%
17%

Tu.
Th. 15%
13% Wed.
14%

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Physician #4
• 91 sessions.
• 0%
prescription
rate.

Physician #6

• 62 sessions.
• 96%
prescription
rate.
• 42.2% visits
had 3+ drugs
prescribed.
Results: Multivariate Regressions
Dependent Var. •OR>1
Prescription Rate Prescription Count attribute
increase the
likelihood of
Independent Var. Odds p value Incidence p value
prescription.
Ratio Rate
Estimate
•OR<1
(Intercept) 0.78 0.36 0.58*** 0 Otherwise
Time of Day 6 a.m.-12 p.m. 1.59* 0.06 1.26 0.05
12 p.m. -5 p.m. 1.04 0.86 1.09 0.49 •*** p<0.01
•** p<0.05
5 p.m. -10 p.m. 1.31 0.29 1.15 0.23
•* p<0.1
Day of Week Weekend 0.78* 0.08 0.96 0.51
Gender Male 3.10*** 0.00 1.48*** 0
Specialty Primary Care 1.42** 0.02 1.15** 0.02
Practice Frequency 51-100 times 0.48 0.38 0.97 0.68

Over 100 times 1.15 0.40 0.99 0.87

Interpretation: Multivariate Regressions

n The male providers are roughly 2.1 (odds ratio -1) times
more likely to prescribe than the female providers.
n The male providers prescribe 0.48 (Incidence Rate
Ratio – 1) unit more than the female providers.

n The primary care providers are roughly 42% time more

likely to prescribe and give 0.15 unit more than the
Emergency Medicine specialists.
Discussion
Key Clinical Findings:
§ Physicians’ Gender and Specialty are the strongest predictors
of both Prescription Likelihood and Prescription Count.
§ Male and Primary Care providers are more likely to prescribe
at a given consultation and often prescribe greater count of
drugs.

Other Observations:
§ VUC facilitates after-hours and weekend visits.
§ more timely and accessible medical service due to the around-
the-clock availability of telemedicine physicians.
Discussion
§ Quality and Reproducibility of prescription results.
§ VUC‘s 69% prescription rate varied from the results of another
similar studies (19%).3
§ The potential lack of guidelines in telemedicine practice.
§ Design Educational and training programs for telemedicine
physicians.
§ Create evaluation metrics.
§ Including Patients’ Attributes into the analysis:
§ Age, gender, race, socioeconomic status, etc.
§ Qualitative assessment:
§ Physicians’ attitude toward prescribing online.
Acknowledgements

§ Master Advisor:
§ Saif Khairat, PhD, MPH, FAMIA

§ UNC Healthcare:
§ Barbara Edson, RN, MHA, MBA
§ Robert Gianforcaro, DO, FAAFP

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Other publications on VUC

§ Khairat, S., Haithcoat, T., Liu, S., Zaman, T., Edson, B., Gianforcaro,
R., & Shyu, C. (2019). Advancing Health Equity and Access Using
Telemedicine: A Geospatial Assessment. Journal of the American
Medical Informatics Association, 26(8-9).
§ Khairat, S., Liu, S., Zaman, T., Edson, B., & Gianforcaro, R. (2019).
Factors Determining Patient’s Choice between mHealth and
Telemedicine: A Predictive Analytics Assessment. JMIR MHealth
and UHealth, 7(6).
§ Liu, S., Zaman, T., Edson, B., Gianforcaro, R., & Khairat, S. (2019).
Analyzing the Demographics of Virtual Care Users. Medinfo 2019.

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Reference
1. Aoki N, Dunn KIM, Johnson-Throop KA, Turley JP. Outcomes and Methods
in Telemedicine Evaluation. Telemed e-Health. 2003;9(4):393–401.
2. Stolley P, D. L, Becker MH, Lasagna L, McEvilla JD, Sloane LM. The
Relationship between Physician Characteristics and Prescribing
Appropriateness. Med Care. 1972;10(1):17–28.
3. Moth G, Huibers L, Christensen MB, Vedsted P. Drug prescription by
telephone consultation in Danish out-of-hours primary care: A population-
based study of frequency and associations with clinical severity and diagnosis.
BMC Fam Pract. 2014;15(142):1–7.
4. McConnochie KM, Roghmann KJ, Goepp J, Herendeen NE, Wood NE, Ahn
DS, et al. Differences in Diagnosis and Treatment Using Telemedicine Versus
In-Person Evaluation of Acute Illness. Ambul Pediatr. 2006;6(4):187–95.

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 Thank you!
Email me at:
songzi@live.unc.edu