Paper highlights shortcomings in telemedicine amid pandemic

Despite increased use of telemedicine during the novel coronavirus (COVID-19) pandemic, Americans have had significantly fewer consultations with primary care doctors and markedly fewer assessments of common cardiac risk factors, according to a new study led by researchers at Johns Hopkins Bloomberg School of Public Health and published in JAMA Network Open.

For the study, researchers examined the National Disease and Therapeutic Index (NDTI), a nationally representative audit of outpatient care.

The study found that the number of primary care consultations fell by more than 21 percent during the second quarter of 2020, compared with the average second-quarter visit volume from the second quarters in 2018 and 2019. That drop in 2020 occurred despite a large, simultaneous surge in telemedicine, which increased from almost zero in prior years to about 35 percent of primary care visits from April through June 2020.

The study also found that the frequency of blood pressure and cholesterol assessments dropped by about 50 percent and 37 percent, respectively. These assessments typically require in-person care, the researchers said.

According to the researchers, the results suggest a potential collateral effect of the COVID-19 pandemic, greater undiagnosed cardiovascular disease and less risk-factor monitoring than typically takes place through office-based primary care.

"These results indicate that there has been a significant decline in primary care use,” said Caleb Alexander, MD, lead author of the study and a practicing internist and professor in the Department of Epidemiology at the Bloomberg School, in a statement, “at least in the early phases of the pandemic, and that telemedicine is an imperfect substitute for many office-based consultations.”

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