Decrease in primary care visits, but increase in telemedicine during COVID-19 pandemic in USA
Use and Content of Primary Care Office-Based vs Telemedicine Care Visits During the COVID-19 Pandemic in the USLiterature - Alexander GC, Tajanlangit M, Heyward J, et al. - JAMA Netw Open. 2020;3(10):e2021476. doi:10.1001/jamanetworkopen.2020.21476
Introduction and methods
The COVID-19 pandemic has been associated with many early health care consequences, ranging from postponement of elective care to closures of clinics and hospitals [1,2]. It was expected that there would be a substantial increase in telemedicine or remote clinical services during the first months of the COVID-19 pandemic. A recent update suggested that delivery of telemedicine increased in April and subsided modestly since then (although still substantially higher than before the pandemic) . Changes in federal and state guidance and reimbursement have accompanied changes in delivery of telemedicine. In addition, structural and social factors have an impact on adoption of telemedicine [4,5].
Studies of telemedicine adoption during the COVID-19 pandemic have been performed, but were small or nonrepresentative, and without description of content [3,6].
In this study, national changes in the volume and type of primary care associated with the COVID-19 pandemic were quantified. In addition, assessment of blood pressure and cholesterol measurement, information on initiation or continuation of prescription medicines for hypertension and dyslipidemia were collected. Furthermore, variance in telemedicine use across different patient populations and geographic regions of the US were examined.
A cross-sectional analysis was performed, focusing of the first quarter (Q1) of 2018 through the second quarter (Q2) of 2020. The IQVIA National Disease and Therapeutic Index was used, a nationally representative audit of outpatient practice in the US. Data from approximately 4000 physicians during each calendar quarter are collecting, containing documentation of each patient encounter. This analysis was restricted to primary care visits.
- In 2020 there was a decrease of 21.4% quarterly primary care visits in the US from the average number of Q2 encounters in 2018 and 2019.
- There was a decrease of 50.2% of average quarterly office-based visits in 2020 compared with Q2 2018-2019 visits.
- Telemedicine visits increased 1.1% of visits in 2018-2019 to 4.1% in Q1 of 2020 and 35.3% in Q2 of 2020.
- Increases in telemedicine visits were similar among white and black individuals (19.3% of 2020 treatment visits among white and 20.5% of those in black individuals).
- Individuals aged 19-35 years and those aged 36-55 years accounted for 17.8% and 26.1% of telemedicine visits, indicating substantial adoption of telemedicine compared to younger or older counterparts (those <19 years: 15.6% of visits; and individuals 56-65: 15.2%; and those ≥ 66 years: 25.3%).
- The proportion of visits delivered by telemedicine varied from 15.1% in the East North Central region (Wisconsin, Michigan, Illinois, Indiana, Ohio) to 26.8% in the Pacific region. Case fatality rate across these regions ranged from 19.90 to 124.91 per 100.000 individuals. There was no association between use of telemedicine and COVID-19 burden across geographic regions.
- A decrease of 50.1% was observed in blood pressure assessments during visits in Q2 of 2020 from Q2 2018-2019 levels. Cholesterol assessments decreased by 36.9% over the same period and reductions in number of office-based and telemedicine visits with the initiation (26%) or continuation (8.9%) of new medicines were also observed.
- Assessment of blood pressure and cholesterol was significantly less common among telemedicine than office-based visits in Q2 2020 (69.7% had a blood pressure recorded at office-based visits vs. 9.6% of telemedicine visits, P<0.001; cholesterol was assessed at 21.6% office-visits vs. 13.5% telemedicine-visits. P<0.001).
- New prescription medications were ordered in similar proportions of Q2 2020 office-based and telemedicine visits, but absolute numbers decreased by 26.0% in Q2 2020 from Q2 2018-2019.
In the US during the COVID-19 pandemic in Q2 of 2020, a dramatic decrease in primary care delivery was observed, together with an increase in use of telemedicine (>35% of primary care visits vs. 1.1% during 2019). Assessment of blood pressure and cholesterol were reduced, due to fewer total visits and less assessment during telemedicine visits. Structure of primary care had changed during the COVID-19 pandemic and the content of telemedicine was different than that of office-based visits.