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COVID-19 Resource Center
Perspective from Eric Wallace, MD, FASN
Perspective from Irfan Asif, MD
Source/Disclosures
Disclosures: Alexander reports serving as past chair of the FDA’s Peripheral and Central Nervous System Advisory Committee, paid advisor to IQVIA, cofounding principal and equity holder in Monument Analytics, and a member of OptumRx’s National P&T Committee. Chew, Jackson and Thronson report no relevant financial disclosures. Please see the study for all other authors’ relevant financial disclosures.
October 02, 2020
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Despite surge in telehealth, primary care visits drop 21% amid COVID-19

Perspective from Eric Wallace, MD, FASN
Perspective from Irfan Asif, MD
Source/Disclosures
Disclosures: Alexander reports serving as past chair of the FDA’s Peripheral and Central Nervous System Advisory Committee, paid advisor to IQVIA, cofounding principal and equity holder in Monument Analytics, and a member of OptumRx’s National P&T Committee. Chew, Jackson and Thronson report no relevant financial disclosures. Please see the study for all other authors’ relevant financial disclosures.
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In the United States, primary care visits declined 21.4% during the second quarter of 2020 compared with average visit volumes in 2018 and 2019, according to study results recently published in JAMA Network Open.

The results also revealed a 50.1% reduction in BP evaluations and 36.9% reduction in cholesterol evaluations during primary care consultations.

G. Caleb Alexander, MD

The drop in primary care visits occurred despite a surge in telehealth, which accounted for less than 2% of primary care visits during 2019 and more than 35% of primary care visits from April to June 2020, according to researchers.

“Our results underscore the potential promise and perils of telemedicine,” lead author G. Caleb Alexander, MD, a practicing internist and professor in the department of epidemiology at the Bloomberg School of Public Health, told Healio Primary Care. “Telemedicine is perfectly suitable for many types of care but it’s highly limited in many settings, as well. Our finding of such large reductions in BP and cholesterol assessments raises concern about the limits of telemedicine in providing an important component of primary care.”

Previous data have demonstrated large increases in the use of telehealth since the start of the COVID-19 pandemic, Alexander said. For the current study, the research team examined the content of these visits, he added.

The researchers analyzed data from the National Disease and Therapeutic Index, a nationally representative audit of outpatient visits conducted by the health care technology company IQVIA. The data are collected from about 4,000 physicians in the U.S. during each calendar quarter.

From January 2018 to December 2019, there were between 122.4 million and 130.3 million quarterly primary care visits in the U.S., most of which occurred in the office (92.9%). In 2020, there were 117.9 million visits during the first quarter and 99.3 million visits during the second quarter.

The researchers estimated there were 27 million fewer visits during the second quarter of 2020 compared with the second quarters of 2018 and 2019, representing a 21.4% decline.

Office-based visits declined from about 116.9 million in the second quarters of 2018 and 2019 to 58.7 million during the second quarter of 2020, representing a 50.2% decline. Meanwhile, telehealth visits increased from 1.4 million visits to 35 million visits.

During primary care consultations, the researchers observed substantial reductions in BP (44.4 million visits) and cholesterol (10.2 million visits) evaluations during the second quarter of 2020 vs. 2018 and 2019 levels. These evaluations were significantly less likely to occur during telehealth visits than office-based visits (9.6% vs. 69.7% for BP; 13.5% vs. 21.6% for cholesterol). In addition, there was a 26% decline in visits for new medications during the second quarter of 2020 compared with 2018 and 2019 levels.

The researchers concluded that declines in BP and cholesterol evaluations were associated with fewer assessments during telehealth visits. Moving forward, Alexander said PCPs will need to consider strategies that help determine which patients can be evaluated virtually and which ones require an office visit.

“Patients are relying on us to get this right,” he said. “I think the question is ... are there resources and best practices that can be developed at regional, state and federal levels to assist in this process? This is something that every practice in the country has thought about and is going to have to continue to manage as we continue to navigate the pandemic.”

In a related editorial, L. Renata Thronson, MD, Sara L. Jackson, MD, MPH, and Lisa D. Chew, MD, MPH, of the division of general internal medicine at the University of Washington, Seattle, said it will be “difficult to rely on a common algorithm” when deciding between virtual and in-person visits for patients.

“Our approach as primary care physicians is to share that decision-making with patients,” they wrote. “There are some patients we would strongly prefer to examine in person, but many of those are most susceptible to COVID-19 or live far away or have out-of-pocket expenses that make an in-person visit prohibitive. Ultimately, we weigh the risks and benefits of virtual care with our patients, falling back on the imperative to provide patient-centered primary care.”

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