Telehealth offsets primary care visit declines but not equally

Though the drop in primary care visit volume was partially offset by telehealth use during the COVID-19 pandemic, new research reveals that these changes varied significantly across patient characteristics, with significant declines in overall visit volume among patients with more comorbidities, among others.

Published in the Annals of Family Medicine, the study examined how the decreases in primary care visit volume and increases in telehealth utilization nationwide differed across patient groups during the pandemic. The COVID-19 pandemic threw into sharp relief the healthcare disparities that curbed care access for some demographic groups. Various social determinants of health factors, including race, location of residency, and primary language, can hinder healthcare access.

For the study, American Board of Family Medicine researchers assessed an EHR data set for primary care that included patient data from March 15, 2019, through March 14, 2021. They used the data set to study three outcomes: the change in total visit volume, the change in in-person visit volume, and the telehealth conversion ratio, which they defined as the number of telehealth visits during the pandemic divided by the total number of pre-pandemic visits. They then examined whether these outcomes were associated with patient demographic characteristics.

The study sample included 1.65 million patients from 408 practices.

The researchers observed a 7% decrease in the average number of total visits and a 17% decrease in the average number of in-person visits during the pandemic. Additionally, they found that the telehealth conversion ratio was 10%.

The study shows that the largest decreases in overall visit volume occurred among pediatric patients (24%), Asian patients (11%), and those with more comorbidities (9%).

"Though this steep decrease was partially offset by a rapid shift to telehealth, it is hard to understate the potential effect of this decrease on patients and practices alike," the researchers wrote. "Patients with chronic care needs might be faced with more long-term complications, owing to missed care during the pandemic, whereas others might experience increases in cancer rates and mortality as a result of missed screenings."

The smallest decreases in total visit volume occurred among patients aged 18 to 64 and Black or African American patients, with both groups experiencing a 2% decline.

Further, researchers found telehealth utilization was highest among Hispanic or Latino patients, who had a telehealth conversion ratio of 17%, and those living in urban areas, with a telehealth conversion ratio of 12%.

"These variations have implications not only for the long-term consequences of the COVID-19 pandemic, but also for planners seeking to ready the primary care delivery system for any future systematic disruptions and to mitigate any potential exacerbation of existing disparities," the researchers concluded.

The study tempers expectations of telehealth's potential to enhance primary care amid research indicating clinicians' enduring interest in virtual primary care.

Though telehealth use dropped by over 30% across various primary care specialties in 2021 and 2022, primary care physicians have largely positive perceptions of telehealth.

Data from the Centers for Disease Control and Prevention (CDC) revealed that nearly 77% of primary care physicians said the quality of care they could provide during telehealth and in-person visits was similar.

The data was gathered from the 2021 National Electronic Health Records Survey, which polled 10,302 office-based physicians. Of these, 1,875 responded to all key items on the survey.

Additionally, the survey shows that 65.5% of primary care physicians were satisfied with telehealth technology.

Anuja Vaidya has covered the healthcare industry since 2012. She currently covers the virtual healthcare landscape, including telehealth, remote patient monitoring, and digital therapeutics.