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. 2021 Jul 9;2(7):e211529.
doi: 10.1001/jamahealthforum.2021.1529. eCollection 2021 Jul.

Changes in Short-term, Long-term, and Preventive Care Delivery in US Office-Based and Telemedicine Visits During the COVID-19 Pandemic

Cecilia Cortez  1 , Omar Mansour  2 , Dima M Qato  3   4 , Randall S Stafford  5 , G Caleb Alexander  6   7   8
Affiliations

Changes in Short-term, Long-term, and Preventive Care Delivery in US Office-Based and Telemedicine Visits During the COVID-19 Pandemic

Cecilia Cortez et al. JAMA Health Forum. .

Abstract

Importance: While the COVID-19 pandemic has been associated with some substitution of telemedicine for office-based care in the US, to our knowledge, little is known regarding the pandemic's association with the clinical content of ambulatory care.

Objective: To characterize changes in the clinical content of ambulatory care among office-based vs telemedicine encounters in the US before vs during the COVID-19 pandemic.

Design settings and participants: This analysis of serial cross-sectional data from the IQVIA National Disease and Therapeutic Index was a 2-stage, stratified nationally representative audit of outpatient care in the US from January 1, 2018, through December 31, 2020. The National Disease and Therapeutic Index generates approximately 33 617 quarterly visits that are projected to 306.7 million national visits based on the survey design.

Main outcomes and measures: (1) Prevalence of common diagnoses and (2) mix of long-term, short-term, and preventive care.

Results: The mean (SD) number of projected quarterly, in-person, office-based visits was 282.1 (1.4) million in 2018 and 284.7 (10.3) in 2019 before declining to 250.8 million in quarter 1 of 2020 and 147.8 million in quarter 2 of 2020 and then increasing moderately to 181.5 million in quarter 3 of 2020 and 180.2 million in quarter 4 of 2020. The mean (SD) number of telemedicine visits was 2.8 (0.4) million in 2018 and 3.0 (0.1) million in 2019 before increasing to 8.6 million in quarter 1 of 2020 and 72.2 million in quarter 2 of 2020 and then declining notably to 43.8 million in quarter 3 of 2020 and 44.2 million in quarter 4 of 2020. Office-based care during the second through fourth quarters of 2020 involved 58.0% long-term, 23.0% short-term, and 25.6% preventive care. In contrast to office-based care, 4 of the top 10 diagnoses that were treated by telemedicine during 2020 were for psychiatric or behavioral conditions: depression, attention deficit/hyperactivity, anxiety, and bipolar disorders. Throughout this period, approximately half of office-based visits and nearly two-thirds of telemedicine visits were for established rather than new patients.

Conclusions and relevance: This cross-sectional study's findings suggest that while telemedicine rapidly increased early during course of the COVID-19 pandemic, its use declined modestly since then. In contrast to office-based care, telemedicine was more commonly used for established patients and substantially greater delivery of psychiatric or behavioral treatments rather than preventive care.

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Conflict of interest statement

Conflict of Interest Disclosures: Dr Alexander reported being a past chair and current member of the US Food and Drug Administration’s Peripheral and Central Nervous System advisory committee, receiving advisory fees from IQVIA, cofounding and holding equity in Monument Analytics, and being a member of OptumRx's National P&T committee. No other disclosures were reported.

Figures

Figure 1.
Figure 1.. Monthly Trends in Office-Based and Telemedicine Visits and Percentage of New Visits by Setting in the US From 2018 to 2020
Based on a total of 3240 million visits. Figure generated with permission from IQVIA.
Figure 2.
Figure 2.. Trends in Short-term, Long-term, and Preventive Visits Before (2018/2019) and During (2020) the COVID-19 Pandemic by Visit Setting
Based on a total of 1485 million visits. Figure generated with permission from IQVIA.
Figure 3.
Figure 3.. Trends in Top Office-Based and Telemedicine Diagnoses Across All Visits During 2020
Based on a total of 3228 million visits. Figure generated with permission from IQVIA.
See this image and copyright information in PMC

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