Has Telehealth Filled the Primary Care Gap During the Pandemic?

Telehealth visits did account for 35 percent of all primary care encounters in Q2 2020, but it wasn’t enough to fill the primary care void at the height of COVID-19

Rajiv Leventhal Oct 12th, 2020

In response to the pandemic and shelter-in-place orders earlier this year, providers aggressively turned to telehealth for care delivery, when possible. But new research now shows that primary care visits still dropped 21 percent during the second quarter of 2020, even after accounting for telehealth appointments.

Researchers from Johns Hopkins and elsewhere looked at 125.8 million primary care visits in the 10 calendar quarters between Q1 of 2018 and Q2 of 2020, finding that primary care visits decreased by 21.4 percent during the second quarter of 2020 compared with the average quarterly visit volume of the second quarters of 2018 and 2019. The research was recently published in JAMA Network Open.

As the study’s authors noted, early reports suggested that substantial increases could be expected in the delivery of telemedicine, or remote clinical services, during the first few months of the pandemic in the U.S. They added that investigations of telemedicine during the pandemic, while yielding insights, have generally been based on small or nonrepresentative samples and limited to analyses of the frequency of such encounters rather than descriptions of their content.

Drilling down into the data, the study specifically revealed that in the eight calendar quarters between Jan. 1, 2018, and Dec. 31, 2019, between 122.4 million and 130.3 million quarterly primary care visits occurred in the U.S., 93 percent of which were office-based. In 2020, meanwhile, the total number of encounters decreased to 117.9 million in Q1 and 99.3 million in Q2, a decrease of 27 million visits, or 21.4 percent from the average of Q2 levels during 2018 and 2019.

Office-based visits decreased 50 percent (59.1 million visits) in Q2 of 2020 compared with Q2 2018-2019, while telemedicine visits increased from 1 percent of total Q2 2018-2019 visits (1.4 million quarterly visits) to 4 percent in Q1 of 2020 (4.8 million visits), before skyrocketing up to 35.3 percent in Q2 of 2020 (35 million visits).

Overall, the pandemic has been associated with marked reductions in the primary care assessment of cardiovascular risk factors such as blood pressure and cholesterol levels, owing to decreased total visit volume and less frequent assessment during telemedicine visits than during office-based visits, the researchers found.  To that point, they stated, “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.”

What’s more, middle-aged individuals and those who were commercially insured were more likely to adopt telemedicine during the pandemic than their counterparts with other or no insurance, the data showed. This difference may be due in part to the perceived elective or deferrable nature of visits among children and greater familiarity with telemedicine technology among middle-aged than among older adults, the researchers hypothesized. Further, there was no found association between the use of telemedicine and the pandemic burden across geographic regions.

There were also no substantial differences in telemedicine use by payer type, and, contrary to the researchers’ expectations and evidence of a digital divide, they did not find evidence of a racial disparity in telemedicine use when examining the frequency of telemedicine encounters as a proportion of a patient visits among Black versus White individuals.