Increase in remote visits affects CV patient care in COVID-19 era
Race, ethnicity and age played a role in the frequency of ambulatory CV care visits, whereas testing and medication orders decreased in the COVID-19 era compared with the pre-COVID era, according to a study published in JAMA Network Open.
A cross-sectional study of 176,781 ambulatory cardiology visits included in-person visits in the pre-COVID-19 period, COVID-19-era in-person visits, COVID-19-era video visits and COVID-19-era telephone visits, according to researchers. The researchers defined the COVID-19 era as April to December 2020 and the pre-COVID-19 era as April to December 2019.
“The take-home message from this study is that clinicians seem to practice differently during remote visits compared to in-person visits,” Neal Yuan, MD, a cardiology fellow in the Smidt Heart Institute at Cedars-Sinai, told Healio. “This difference means that remote visits need dedicated attention to help better define what are the most effective telehealth practices and where there may be opportunities to further improve. While remote visits have been selectively used by some for many years, the COVID-19 pandemic has jumpstarted widespread adoption, and I would anticipate that remote visits will continue to be widely used even after the pandemic wanes.”
In the analysis, Asian, Black or Hispanic individuals were more likely to pursue remote visits (pre-COVID-19 in-person visits, 28.6%; COVID-19-era in-person visits, 26.5%; COVID-19-era video visits, 30.4%; COVID-19-era telephone visits, 35%; P < .001 for all comparisons).
According to the researchers, a larger percentage of remote visits occurred among patients who had private insurance (pre-COVID-19 in-person visits, 39.1%; COVID-19-era in-person visits, 34.2%; COVID-19-era video visits, 54.3%; COVID-19-era telephone visits, 41.1%; P < .001 for COVID-19-era in-person vs. video and COVID-19-era in-person vs. telephone).
Researchers observed that patients who opted for in-person and telephone visits tended to be of comparable age, whereas those who chose a video visit had a younger mean age (pre-COVID-19 in-person, 67.7 years; COVID-19 era in-person, 69 years; COVID-19 era video, 61.1 years; COVID-19 era telephone, 68.4 years; P < .0001 for COVID-19-era in-person vs. video and COVID-19-era in-person vs. telephone).
According to the researchers, patients who sought remote visits tended to have more CV comorbidities, including hypertension, atrial fibrillation, HF and chronic kidney disease.
Medication ordering trends
After multivariable adjustments for visit and patient characteristics, compared with pre-COVID-19 in-person visits, clinicians had lower odds of ordering any medications as a result of COVID-19-era visits (adjusted OR for in-person visits = 0.62; 95% CI, 0.6-0.64; aOR for video = 0.22; 95% CI, 0.2-0.24; aOR for telephone = 0.14; 95% CI, 0.13-0.15).
Also, clinicians were less likely to order diagnostic and lab tests in the COVID-19 era, regardless of format of visit, compared with the pre-COVID-19 era, according to the researchers.
“The decrease in testing and medication prescription seen with remote visits affected all patients regardless of demographics, including race and ethnicity,” Yuan told Healio. “Therefore, we believe that the changes in practice patterns seen with remote care are more a reflection of differences due to the remote nature of visits rather than the patient populations that use remote care. Improving the quality of remote care will be important for all patient groups, and especially for those who use remote care most frequently.”
For more information:
Neal Yuan, MD, can be reached at email@example.com.