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Despite the increased use of telemedicine during the COVID-19 pandemic, Americans have had significantly fewer consultations with primary care physicians and significantly fewer assessments of more common cardiac risk factors, according to a new study conducted by researchers at the Johns Hopkins Bloomberg School of Public Health.
The study found that the number of primary care consultations in the second quarter of 2020 decreased by more than 21 percent compared to the average visit volume in the second quarter of the second quarters of 2018 and 2019. This decrease in 2020 was despite a large, simultaneous increase telemedicine – which rose from almost zero in previous years to around 35 percent of visits to primary care between April and June 2020.
The study, which is based on an ongoing review of outpatient care in the United States, also found that the frequency of blood pressure and cholesterol levels decreased by about 50 percent and 37 percent, respectively. These assessments, important tools for identifying increased risks for cardiovascular disease, usually require personal attention.
The results suggest a possible collateral effect of the COVID-19 pandemic – greater undiagnosed cardiovascular disease and lower risk factor monitoring than is usually the case with primary care inpatients.
The study will be published on October 2 in the JAMA Network Open.
"These results suggest that the use of primary care has decreased significantly, at least in the early stages of the pandemic, and that telemedicine is an imperfect substitute for many office-based consultations," says study leader G. Caleb Alexander. MD, practicing internist and professor in the Epidemiology Department at Bloomberg School.
The COVID-19 pandemic has directly caused more than a million deaths worldwide, with more than 200,000 occurring in US social distancing and health care restructuring guidelines to prioritize COVID care and the potential for transmission in the Health care related to reduce severe restriction in activities of normal living, including routine doctor visits. During this time, the reliance on telemedicine, where doctors consult their patients over the phone or over the Internet, has also increased. However, the precise effects of telemedicine on the level and content of primary care are unclear.
For their study, Alexander and colleagues examined the National Disease and Therapeutic Index (NDTI), a nationally representative review of outpatient care by IQVIA, a health technology company.
A key finding was that the estimated number of primary care consultations rose from an average of 126.3 million per quarter in the second quarters of 2018 and 2019 to 99.3 million in the period April to June 2020, the first full quarter after the start of the COVID- , has decreased. 19 US crisis
This represents a decrease of 21.4 percent, and the results show that this decrease was despite an unprecedented increase in the use of telemedicine – from 1.1 percent of all visits in Q2 2018 and Q2 2019 to 35, 3 percent in the 2nd quarter of 2020.
The analysis also found that the estimated number of visits to primary care in practice decreased by 50.2 percent from the average of the second quarter 2Q-2018/2019 to 2Q-2020.
The researchers looked at multiple assessments or interventions commonly performed during primary care consultations and again found sharp drops from averages for Q2 2018/2019 to Q2 2020. These included a 26.0 percent decrease in drug initiation or renewal visits, a 50.1 percent decrease in blood pressure controls and a 36.9 percent decrease in cholesterol.
The sharp drop in blood pressure and cholesterol levels during the pandemic reflects both a decrease in the overall volume of visits to primary care and the less frequent assessment of these cardiac risk factors during telemedicine consultations.
"These aren't trivial declines: they are large, clinically important declines that affect two of the most basic elements of primary care – heart attack and stroke prevention," says Alexander. "Hence, these results raise serious concerns about the collateral impact of the COVID-19 pandemic on cardiovascular disease prevention in the United States."
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"Use and Content of Telemedicine in Primary Care During the Covid-19 Pandemic in the US" JAMA Network Open (2020). DOI: 10.1001 / jamanetworkopen.2020.21476
Bloomberg School of Public Health at Johns Hopkins University
The study reveals shortcomings in telemedicine, although the number of remote consultations has increased sharply during the COVID-19 pandemic (2020, October 2nd).
accessed on October 2, 2020
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