Telehealth Outpatient Care Delivery Increased During Pandemic

Telehealth visits for short- and long-term outpatient care delivery increased during the coronavirus pandemic, while in-person services saw more preventive care visits, according to a study from the Journal of the American Medical Association (JAMA). 

By now, it’s common knowledge that telehealth services expanded during 2020. With the study, researchers from Johns Hopkins, USC and, Stanford sought to learn how the pandemic affected telehealth use for outpatient care services.

They used data from the IQVIA National Disease and Therapeutic Index, a nationally representative audit of outpatient care in the United States. They examined the data quarterly, starting with January 1, 2018 and ending with December 31, 2020.

Before comparing telehealth and in-person trends, researchers noted the most common diagnoses for all outpatient care visits and sorted the conditions into short-term, long-term, and preventive care categories.

Between the first quarter of 2018 and the last quarter of 2019, in-person care saw around 282 million visits each quarter. In the second quarter of 2020, when the pandemic was in full swing, that number dropped significantly to 147.8 million quarterly visits. The number of visits rose to around 180 million during quarters three and four. As in-person care visits declined, telehealth visits increased, and vice versa, according to the data.

The average number of quarterly telehealth visits in 2019 was 3 million. During the pandemic, that number increased to 8.6 million in quarter one of 2020 and hit its peak of 72.2 million visits during quarter two. The amount of quarterly telehealth visits declined toward the end of the year to around 44 million.

Along with the telehealth and in-person care fluctuations, there were also noticeable trends regarding short-term, long-term, and preventive care delivery, the study showed. Short-term and long-term conditions saw increased telehealth visits compared to pre-pandemic rates. 

In 2018 and 2019, short-term care accounted for an average of 24 percent of all telehealth services. During the pandemic, it increased to 26 percent. Long-term care’s telehealth percentage increased from an average of 71.6 percent in 2018 and 2019 to 77.1 percent in 2020. In contrast, in-person visits experienced a nearly 5 percent decline for long-term care from pre-pandemic to 2020. 

Preventive care, on the other hand, saw a decrease in telehealth use during the pandemic, going from a 5.3 percent average in 2018 and 2019 to 2.6 percent in 2020. In-person care visits increased for these services. 

Patients used the most telehealth services during the pandemic for psychiatric care, accounting for 61.7 percent of all telehealth visits in 2020, according to the study. Care that may require more hands-on treatment such as general surgery or ophthalmology accounted for low telehealth use, with 5.3 percent and 2.2 percent, respectively.

The data also showed that telehealth was more popular for established care rather than new visits. In every quarter from 2018 to 2020, the percent of subsequent visits was substantially higher than the percent of new visits. The pandemic only shifted these figures slightly. 

For example, the average percentages in quarter two of 2018 and 2019 were 27.5 percent new visits and 72.4 percent for subsequent visits. In 2020 during quarter two, new visits accounted for 37.1 percent of all telehealth visits with 63.5 percent designated as subsequent visits.

The pandemic brought an increase in mental health conditions, causing the demand for behavioral health services to increase as well. As the JAMA study results showed, telehealth use was most popular for treating psychiatric and behavioral health conditions such as depression, anxiety, and bipolar disorder. 

Researchers mentioned the flexibility that accompanies telehealth use for mental health conditions, citing the ability to access care from home and not having to take time off work.  

The majority of patients attended in-person visits for preventive care as opposed to telehealth, which could explain the overall decrease in preventive care delivery during the pandemic, the study explained.

“Our findings regarding shifts in long-term, short-term, and preventive care may be associated with reimbursement requirements, because some care, such as pediatric well visits and visits for non-Medicare beneficiaries, must still be performed in person to be reimbursed,” JAMA researchers added.

The study noted that ongoing surveillance is necessary to determine the future of telehealth use for outpatient care delivery due to the ever-changing circumstances of the pandemic.