Study of Telehealth Use and In-Person Visits During Pandemic Provides Insight on Deferred Care

Health systems can use data from the new study to target medical conditions and specialties that had the highest rates of deferred care.

Telemedicine utilization by condition and medical specialty during the early phase of the coronavirus pandemic sheds light on deferred care, a new research article shows.

At the beginning of the pandemic, use of telemedicine surged as many clinicians turned to the technology to continue to see patients in a safe manner. Despite the uptick in telemedicine use, overall medical visits dropped substantially, which raises concern about deferred care, the new research article says.

The study, which was published today by Health Affairs, is based on data collected from 16.7 million Medicare Advantage and commercial insurance beneficiaries.

The researchers examined data for in-person and telemedicine outpatient care from Jan. 1, 2020, to June 16, 2020. Jan. 1 to March 17 was designated as the "pre-COVID-19 period" and March 18 to June 16 was designated as the "COVID-19 period."

The study generated several key data points:

• 30.1% of total outpatient visits were provided through telemedicine during the COVID-19 period, which amounted to a 23-fold increase in telemedicine use over the pre-COVID-19 period
   
• Despite the increase in telemedicine visits during the COVID-19 period, overall outpatient visit volume fell 35.0%
   
• During the COVID-19 period, at least half of clinicians in six specialties used telemedicine at least once: endocrinologists (67.7%), gastroenterologists (57.0%), neurologists (56.3%), pain management physicians (50.6%), psychiatrists (50.2%), and cardiologists (50.0%)
   
• During the COVID-19 period, specialties that generally require in-person visits provided at least one telemedicine visit at a relatively low level, including orthopedic surgeons (20.7%), ophthalmologists (9.3%), physical therapists (6.6%), and optometrists (3.3%)
   
• Specialties that conducted a larger percentage of total visits via telemedicine in the COVID-19 period had a smaller decrease in total visits per week from the pre-COVID-19 period to the COVID-19 period. During the COVID-19 period, five specialties conducted about half of total visits through telemedicine: psychiatry (56.8%), gastroenterology (54.5%), endocrinology (53.1%), social work (50.8%), psychology (49.1%), and neurology (47.9%).
   
• On average, conditions for which a larger percentage of total visits were conducted through telemedicine in the COVID-19 period had a smaller decrease in total visits per week from the pre-COVID-19 period to the COVID-19 period. Conditions with the highest percentage of total visits provided through telemedicine in the COVID-19 period included mental illnesses such as bipolar disorder (55.0%), anxiety (53.9%), and depression (52.6%). For these conditions, total visits per week fell 11% or less from the pre-COVID-19 period to the COVID-19 period.
   
• Some common chronic conditions had relatively low use of telemedicine and significant drops in total visit volume. For hypertension, 38.1% of visits were conducted through telemedicine and total visits fell 23.0%. For diabetes without complication, 33.9% of visits were conducted through telemedicine and total visits fell 30.6%.
   
• There was low use of telemedicine visits for eye conditions, which was associated with large drops in total visits. For cataracts, 1.2% of visits were conducted through telemedicine and total visits fell 61.2%. For glaucoma, 2.6% of visits were conducted through telemedicine and total visits fell 52.2%.

Healthcare providers could use the research article's findings to target areas with the highest rates of deferred care, the study's co-authors wrote.

"Health systems could allocate resources to patient outreach efforts such as telephone calls or reminder messages, prioritizing patients whose conditions saw the largest drop in visit volume. Furthermore, additional clinical capacity could be allocated to specialties with the largest backlogs of deferred care. Finally, health systems could prioritize chronic illness populations, who were more likely to have deferred care, for targeted population management," they wrote.

Interpreting the data

The data indicates that several specialties stand out for deferred care during the coronavirus pandemic, study co-author Michael Barnett, MD, MS, told HealthLeaders.

"Ophthalmology definitely seems to be the hardest hit. There are plenty of chronic eye conditions that require regular checkups, including glaucoma and many retinal diseases. Other specialties with the largest backlog of deferred care include otolaryngology and dermatology," said Barnett, an assistant professor in the Department of Health Policy and Management at Harvard T.H. Chan School of Public Health in Boston.

During the early phase of the pandemic, specialties with the least telemedicine engagement such as optometrists, physical therapists, and ophthalmologists appear to have been ill-suited for the switch to telehealth, he said. "Our hypothesis is that these specialties rely heavily on in-person contact and may also have had the least infrastructure and cultural preparedness to transition to telemedicine among all specialties."

The relatively low use of telemedicine for common chronic conditions such as hypertension and diabetes without complication along with a significant decline in total visit volume for these conditions raises alarm, Barnett said.

"It is concerning, especially because we worry that the most disadvantaged populations are probably the ones with the most deferred care and highest need to maintain continuity of care. We do not have data yet to know about the magnitude of deferred care that may have led to worsening chronic illness control, but we think it is a very important public health concern to monitor."

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