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Analysis

In Primary Care, COVID-19 Decreased Utilization Despite Telemedicine Uptick

By Christopher Cheney  
   October 06, 2020

New research shows total primary care visits decreased 21.4% in the second quarter of 2020 compared to the second quarters of 2018 and 2019.

Despite a significant increase in telemedicine visits, primary care utilization has fallen significantly during the coronavirus pandemic, a new research article shows.

COVID-19 is a highly infectious and potentially deadly illness. As of Oct. 5, more than 7.6 million Americans had been infected, with more than 210,000 deaths, according to worldometer. Largely due to concern over the spread of the virus in healthcare settings, many patients have avoided in-person primary care visits and physician practices have expanded telemedicine visits.

The new research article, which was published last week by JAMA Network Open, features data collected from millions of primary care visits in the 10 calendar quarters between Q1 of 2018 and Q2 2020. The study has several key data points.

  • From January 2018 to December 2019, quarterly primary care visits ranged from 122.4 million to 130.3 million, with 92.9% of visits conducted in person.
     
  • In 2020, Q1 primary care visits decreased to 117.9 million and Q2 primary care visits decreased to 99.3 million. The Q2 visits were 21.4% lower than the average Q2 levels in 2018 and 2019.
     
  • In-person primary care visits decreased 50.2% in Q2 2020 compared to Q2 in 2018 and 2019.
     
  • Telemedicine primary care visits increased from 1.1% of the total visits in Q2 of 2018 and 2019 to 35.3% of the total visits in Q2 of 2020.
     
  • In Q2 2020 compared to Q2 2018 and Q2 2019, blood pressure level assessment decreased 50.1% and cholesterol level assessment decreased 36.9%.
     
  • Blood pressure and cholesterol assessments were lower in telemedicine visits compared to in-person visits. Blood pressure was assessed in 9.6% of telemedicine visits vs. 69.7% of in-person visits. Cholesterol was assessed in 13.5% of telemedicine visits vs. 21.6% of in-person visits.

Interpreting the data

During the pandemic, telemedicine visits have partially offset a significant decrease in total primary care visits, the new research article's co-authors wrote. "The pandemic has been associated with a more than 25% decrease in primary care volume, which has been offset in part by increases in the delivery of telemedicine, which accounted for 35.3% of encounters during the second quarter of 2020."

Primary care assessment of cardiovascular risk factors such as blood pressure and cholesterol levels have decreased during the pandemic, due to a reduction in total visit volume and lower assessment rates in telemedicine visits compared to in-person visits. The reduced assessments in telemedicine visits suggest a significant limitation of how telehealth is being practiced, the study's co-authors wrote.

"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," they wrote.

Primary care has undergone fundamental changes during the pandemic, they wrote. "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."

Related: Primary Care Providers Blame COVID-19 for 'Severe' Strain on Practices

Christopher Cheney is the senior clinical care​ editor at HealthLeaders.


KEY TAKEAWAYS

In-person primary care visits decreased 50.2% in the second quarter of 2020 compared to Q2 in 2018 and 2019, a new research article shows.

Telemedicine primary care visits increased from 1.1% of the total visits in Q2 of 2018 and 2019 to 35.3% of the total visits in Q2 of 2020.

Compared to in-person primary care visits, telemedicine visits were less likely to assess blood pressure and cholesterol levels, indicating that telehealth currently has limitations in prevention and chronic disease management.


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