Preventive care dropped during COVID-19 pandemic despite rise in telehealth visits: study

By Heather Landi Oct 8, 2020 11:16am

There have been substantial decreases in primary care delivery during the COVID-19 pandemic despite the rapid uptick in the use of virtual care visits, according to a new study.

Despite the interest in telehealth fueled by the pandemic, virtual care didn't fill in the gap for missed primary care appointments, according to a study published in JAMA Open.

During the height of the COVID-19 pandemic, doctors turned to virtual consultations to continue to provide care to their patients.

Primary care visits decreased by 21% during the second quarter of 2020 compared with the average quarterly visit volume of the second quarters of 2018 and 2019, the study found.

At the same time, telehealth visits, which accounted for fewer than 2% of primary care visits during 2019, jumped to 35% of visits during Q2 of 2020, according to the research.

But there have been marked reductions in the primary care assessment of patients' cardiovascular risk factors such as blood pressure and cholesterol levels as physicians were less likely to conduct these evaluations during telemedicine visits compared to office-based visits, the study found.

Researchers analyzed the U.S. National Disease and Therapeutic Index audit of more than 125.8 million primary care visits in the 10 calendar quarters between first quarter of 2018 and the second quarter of 2020.

"While the COVID-19 pandemic has impacted health care delivery in many ways, little is known regarding how the volume, site, and content of primary care in the U.S. has changed," the study authors wrote.

Of 59 million Q2 2020 office-based visits:

70% had a blood pressure recorded compared with 10% of telemedicine visits during the same time period, the study found.
Cholesterol was also less commonly assessed during telemedicine visits than during office-based visits in Q2 2020, 14% vs 22%, relatively.
New prescription medications were prescribed less often during telemedicine visits versus office-based visits during the second quarter, at 39% vs 45%.

The study results indicate that the COVID-19 pandemic has been associated with changes in the structure of primary care, with the content of telemedicine visits differing from that of office-based encounters.

"These findings are notable because little is known about the association between primary care delivery and the COVID-19 pandemic and because the pandemic has generated interest in telemedicine as a means to safely deliver primary care," the stud authors wrote.

A recent survey found that the majority of physicians (60%) have lingering reservations about the quality of care they can provide remotely.

As of July 2020, 80% of U.S. physicians had conducted a virtual patient consultation in the previous three months—up from 39% in April and 9% in early March, when use of virtual consults was unchanged over 2019 levels, according to a survey of 4,855 practicing U.S. physicians.

But, among the 20% of physicians who did not use telehealth during the past three months, the top reason cited was the possibility of diminished quality of care (49%).

The JAMA Open study found that middle-aged individuals and those who were commercially insured were more likely to adopt telemedicine during the pandemic than their counterparts with other or no insurance.

The researchers did not find substantial differences in telemedicine use by payer type.

"Contrary to our expectations and evidence of a digital divide, we did not find evidence of a racial disparity in telemedicine use when examining the frequency of telemedicine encounters as a proportion of a patient visits among Black versus White individuals," the authors wrote.

If substantial primary care volume continues to be delivered using telemedicine, a focus on the content and quality of such encounters is inevitable, the study said.

"Our finding that such visits were less likely to include blood pressure or cholesterol assessments underscores the limitation of telemedicine, at least in its current form, for an important component of primary care prevention and chronic disease management," the study authors said.

The authors also noted that the degree to which the COVID-19 pandemic may lead to permanent increases in the use of telemedicine remains to be seen.

In response to the pandemic, U.S. federal and state regulators modified policies and procedures, such as the Centers for Medicare & Medicaid Services (CMS) provision of telehealth waivers for providers, to allow greater use of telemedicine to support remote clinical encounters.

"Whether the federal and state rules and regulations that have been modified will be made permanent and whether the current embrace of telemedicine by patients and clinicians will endure remain unknown," the study authors said.

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