Lee Austin, Belt Nicholas G, Mistovich Keili, Mistovich R Justin, Hertz Andrew
Orthopedic Surgery, Case Western Reserve University School of Medicine, Cleveland, USA.
Pediatrics, Zest Pediatrics, Cleveland, USA.
Cureus. 2025 Jun 16;17(6):e86122. doi: 10.7759/cureus.86122. eCollection 2025 Jun.
Direct primary care (DPC) is a transformative alternative to the fee-for-service insurance-based model, offering unlimited patient access for a monthly fee. With growing interest in DPC within pediatrics, our primary objectives were to evaluate how increased access through DPC influences multimodal telehealth utilization and assess its potential to reduce in-person care encounters and costs, including office, urgent care, and emergency department (ED) visits.
A cross-sectional electronic member survey of a multi-physician pediatric DPC network was distributed in April 2023, which assessed the utilization and impact of telehealth modalities and their ability to avoid in-person healthcare visits. Data from the chargemaster of a nearby children's hospital were used as a proxy for the mean costs of pediatric office, urgent care, and ED visits to calculate cost savings for members.
There were 59 parent responses out of 155 for a response rate of 38%; 100% (59/59) reported texting questions to their doctor, 93% sent pictures to the doctor, 88% directly telephoned the doctor, and 22% used video chat. The minimum mean healthcare expenditure avoided by utilizing telehealth modalities is $1,171.13 per year per family. Patient satisfaction with the DPC model demonstrated a Net Promoter Score (NPS) of 98/100.
Our study demonstrates that utilization of telehealth modalities in DPC reduces the frequency of in-person office, urgent care, and ED visits and leads to family cost savings. These findings offer valuable insight for healthcare agencies and professional societies developing policies to support pediatric DPC as a sustainable model that delivers value to families, employers, and payers alike. Limitations include regional cost variations and unspecified total avoided visits, and the number of pediatric patients per family. This may result in an underestimation of family savings. Further research should include a larger sample size with clear specifications on the number of visits avoided and the number of pediatric patients treated.
直接初级保健（DPC）是基于按服务收费保险模式的一种变革性替代方案，每月收取一定费用，为患者提供无限制的就诊机会。随着儿科领域对DPC的兴趣日益浓厚，我们的主要目标是评估通过DPC增加就诊机会如何影响多模式远程医疗的使用，并评估其减少面对面就诊次数和成本的潜力，包括门诊、紧急护理和急诊科就诊。
2023年4月对一个多医生儿科DPC网络进行了横断面电子会员调查，评估了远程医疗模式的使用情况和影响，以及它们避免面对面医疗就诊的能力。附近一家儿童医院收费主表中的数据被用作儿科门诊、紧急护理和急诊科就诊平均成本的代理，以计算会员的成本节省情况。
155份调查问卷中有59份家长回复，回复率为38%；100%（59/59）的家长报告向医生发送过短信咨询问题，93%发送过图片，88%直接给医生打过电话，22%使用过视频聊天。通过使用远程医疗模式，每个家庭每年避免的最低平均医疗支出为1171.13美元。患者对DPC模式的满意度显示净推荐值（NPS）为98/100。
我们的研究表明，DPC中远程医疗模式的使用减少了面对面门诊、紧急护理和急诊科就诊的频率，并为家庭节省了成本。这些发现为医疗保健机构和专业协会制定政策提供了有价值的见解，以支持儿科DPC作为一种为家庭、雇主和付款人带来价值的可持续模式。局限性包括地区成本差异、未明确的总避免就诊次数以及每个家庭的儿科患者数量。这可能导致对家庭节省情况估计不足。进一步的研究应包括更大的样本量，并明确说明避免的就诊次数和接受治疗的儿科患者数量。
