A massive cohort study of over 36 million U.S. patients looks into how ambulatory care patterns changed considering the rise in virtual care in the first months since the start of the COVID-19 pandemic.
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With telehealth services have been present in the U.S. since some time ago, the COVID-19 pandemic has given a boost to this format of care. In areas with high COVID-19 prevalence the share of televisits has been reported to grow as much as 80 times.
A team of researchers analysed the data on 36,568,010 working-age U.S. individuals continuously enrolled in private health plans from March 2019 through June 2020. They compared patterns and costs of ambulatory care between the months of March and June in both 2019 and 2020 to assess how various factors were associated with telehealth adoption.
The findings showed that over the year, the overall number of visits decreased by 18%. Specifically, in-person contacts decreased by 37% while the share of telehealth visits grew from 0.3% of all contacts in 2019 to 23.6% in 2020, with 13.6% of the sample having experienced one or more telehealth interactions. The majority of virtual consultations related to mental/behavioural health issues as compared to medical contacts (46.1% vs. 22.1%).
Other key findings include:
- Higher prevalence of COVID-19 in an area led to wider adoption of telehealth.
- Greater social resources were associated with higher telehealth use (27.4% vs. 19.9% usage rates for most and socially advantaged neighbourhoods respectively).
- Telehealth adoption was higher among those in health maintenance organisations compared to those in standard preferred provider organisations (35.7% vs. 24.1%).
- Telehealth use varieddepending on clinical speciality, e.g. the virtual delivery of surgical and rehabilitation services was much lower than for other types of services (4.6% vs. 9.2%), and on type of disease, as it was much less likely for acute primary diagnoses to be managed in a televisit compared to chronic conditions (14.1% vs. 21.5%). In addition, telehealth services adoption in new patients/health issues was lower than overall rates.
- While the overall cost of medical care decreased by 15% between 2019 and 2020, for those requiring COVID-19-related services it was more than three times higher. Similarly, telehealth encounters cost nearly twice as much as only in-person ambulatory contacts.
While
acknowledging some limitations to their study, the authors note that their
findings are still relevant to “the future trajectory of telehealth no matter
what direction it takes”.
Image credit: mixetto via iStock
