Study highlights shortcomings in telemedicine despite large increases in remote consults during COVID-19 pandemic

October 02, 2020

Despite increased use of telemedicine during the COVID-19 pandemic, Americans have had significantly fewer consultations with primary care doctors and markedly fewer assessments of common cardiac risk factors, according to a new study led by researchers at Johns Hopkins Bloomberg School of Public Health.

The study found that the number of primary care consultations fell by more than 21 percent during the second quarter of 2020, compared with the average second-quarter visit volume from the second quarters in 2018 and 2019. That drop in 2020 occurred despite a large, simultaneous surge in telemedicine--which increased from almost zero in prior years to about 35 percent of primary care visits from April through June 2020.

The study, based on an ongoing audit of outpatient care in the U.S., also found that the frequency of blood pressure and cholesterol assessments dropped by about 50 percent and 37 percent, respectively. These assessments, important tools for detecting elevated cardiovascular disease risks, typically require in-person care.

The results suggest a potential collateral effect of the COVID-19 pandemic--greater undiagnosed cardiovascular disease and less risk-factor monitoring than typically takes place through office-based primary care.

The study will be published October 2 in JAMA Network Open.

"These results indicate that there has been a significant decline in primary care use, at least in the early phases of the pandemic, and that telemedicine is an imperfect substitute for many office-based consultations," says study lead author G. Caleb Alexander, MD, a practicing internist and professor in the Department of Epidemiology at the Bloomberg School.

The COVID-19 pandemic has caused directly more than one million deaths worldwide, more than 200,000 have occurred in the U.S. Social distancing policies as well as health-system restructuring to prioritize COVID care and reduce the potential for health care-related transmission have led to sharp reductions in the activities of ordinary life including routine doctor's visits. During this period, there has also been increased reliance on telemedicine, in which doctors consult with their patients via telephone or the internet, but the precise impact of telemedicine on the level and content of primary care delivery has been unclear.

For their study, Alexander and colleagues examined the National Disease and Therapeutic Index (NDTI), a nationally representative audit of outpatient care conducted by IQVIA, a health care technology company.

One key finding was that the estimated number of primary care consultations fell from an estimated average of 126.3 million per quarter in the second quarters of 2018 and 2019 to 99.3 million during April through June 2020, the first full quarter following the start of the COVID-19 crisis in the U.S.

That represents a drop of 21.4 percent, and the findings indicate that this drop occurred despite an unprecedented surge in telemedicine use--from 1.1 percent of total visits in 2Q-2018 and 2Q-2019 to 35.3 percent in 2Q-2020.

The analysis also showed that the estimated number of office-based primary care visits declined by 50.2 percent from the second quarter 2Q-2018/2019 average to 2Q-2020.

The researchers examined several assessments or interventions that are commonly performed during primary care consultations, and again found large declines from the 2Q-2018/2019 averages to 2Q-2020. These included a 26.0 percent drop in visits where a medicine was initiated or renewed, as well as a 50.1 percent decline in blood pressure checks and a 36.9 percent decline in blood cholesterol tests.

The large declines in blood pressure and cholesterol checks during the pandemic reflect both a decrease in overall primary care visit volume as well as the less common assessment of these cardiac risk factors during telemedicine consultations.

"These are not trivial declines: They are large, clinically important declines involving two of the most fundamental elements of primary care--the prevention of heart attacks and strokes," Alexander says. "So these findings raise serious concerns regarding the collateral effects of the COVID-19 pandemic on cardiovascular disease prevention in the United States."
-end-
"Use and Content of Primary Care Telemedicine During the Covid-19 Pandemic in the United States" was written by Caleb Alexander, Matthew Tajanlangit, James Heyward, Omar Mansour, Dima Qato, and Randall Stafford.

Disclosures: Caleb Alexander is past Chair of FDA's Peripheral and Central Nervous System Advisory Committee; has served as a paid advisor to IQVIA; is a co-founding principal and equity holder in Monument Analytics, a health care consultancy whose clients include the life sciences industry as well as plaintiffs in opioid litigation; and is a member of OptumRx's National P&T Committee.

Johns Hopkins University Bloomberg School of Public Health

Related Blood Pressure Articles from Brightsurf:

Children who take steroids at increased risk for diabetes, high blood pressure, blood clots
Children who take oral steroids to treat asthma or autoimmune diseases have an increased risk of diabetes, high blood pressure, and blood clots, according to Rutgers researchers.

High blood pressure treatment linked to less risk for drop in blood pressure upon standing
Treatment to lower blood pressure did not increase and may decrease the risk of extreme drops in blood pressure upon standing from a sitting position.

Changes in blood pressure control over 2 decades among US adults with high blood pressure
National survey data were used to examine how blood pressure control changed overall among U.S. adults with high blood pressure between 1999-2000 and 2017-2018 and by age, race, insurance type and access to health care.

Transient increase in blood pressure promotes some blood vessel growth
Blood vessels are the body's transportation system, carrying oxygen and nutrients to cells and whisking away waste.

Effect of reducing blood pressure medications on blood pressure control in older adults
Whether the amount of blood pressure medications taken by older adults could be reduced safely and without a significant change in short-term blood pressure control was the objective of this randomized clinical trial that included 534 adults 80 and older.

Brain blood flow sensor discovery could aid treatments for high blood pressure & dementia
A study led by researchers at UCL has discovered the mechanism that allows the brain to monitor its own blood supply, a finding in rats which may help to find new treatments for human conditions including hypertension (high blood pressure) and dementia.

Here's something that will raise your blood pressure
The apelin receptor (APJ) has been presumed to play an important role in the contraction of blood vessels involved in blood pressure regulation.

New strategy for treating high blood pressure
The key to treating blood pressure might lie in people who are 'resistant' to developing high blood pressure even when they eat high salt diets, shows new research published today in Experimental Physiology.

Arm cuff blood pressure measurements may fall short for predicting heart disease risk in some people with resistant high blood pressure
A measurement of central blood pressure in people with difficult-to-treat high blood pressure could help reduce risk of heart disease better than traditional arm cuff readings for some patients, according to preliminary research presented at the American Heart Association's Hypertension 2019 Scientific Sessions.

Heating pads may lower blood pressure in people with high blood pressure when lying down
In people with supine hypertension due to autonomic failure, a condition that increases blood pressure when lying down, overnight heat therapy significantly decreased systolic blood pressure compared to a placebo.

Read More: Blood Pressure News and Blood Pressure Current Events
Brightsurf.com is a participant in the Amazon Services LLC Associates Program, an affiliate advertising program designed to provide a means for sites to earn advertising fees by advertising and linking to Amazon.com.