Physicians' Academy for Cardiovascular Education

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 US

Literature - 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) [3]. 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.

Main results


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.


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