Comparing the quality of video and phone consultations in primary care telemedicine: a cross-sectional study of over 180,000 appointments

Background Telemedicine has gained prominence in primary care, but evidence comparing its modalities is scarce. Methods We conducted a cross-sectional study of 184,308 video and phone consultations from a telemedicine platform in Portugal, comparing quality indicators based on the Institute of Medicine (IOM) domains. Results Video consultations were associated with lower recurrence rates, higher patient-reported helpfulness (95.4% vs. 92.3%), and greater satisfaction. Time to appointment was shorter for phone consultations, but video had a longer duration. Conclusions In this cross-sectional analysis, video consultations were associated with higher patient-reported helpfulness and lower short-term recurrence than telephone consultations, while telephone offered faster access. Because telephone users were substantially older and the dataset lacked measures of comorbidity, illness severity, and socioeconomic status, these associations are likely confounded by indication and should not be read as causal evidence of superior quality. The findings nonetheless point to differences between modalities and to the importance of equitable access to information-richer consultations.