Despite increased use, telemedicine has drawbacks

A new study by researchers at the Bloomberg School of Public Health found that despite the surge in telemedicine adoption during the COVID-19 pandemic, primary care consultations and two important parameters of heart health The number of Americans who have been evaluated for cholesterol and blood pressure is significantly reduced.

A study entitled “Use and Content of Primary Care Office-Based Visits and Telemedicine Care Visits during the COVID-19 Pandemic in the United States” JAMA network open October 2nd.

Dr. Caleb Alexander, a professor of epidemiology and medicine in the Faculty of Public Health, is the lead author of this study.

In an interview with Newsletter, Alexander Early report During the COVID-19 pandemic, concerns about COVID-19 infection have suggested a significant reduction in the proportion of patients seeking face-to-face medical care. At the same time, Alexander and his colleagues observed a surge in telemedicine adoption for primary care counseling, rising from about 1% in the previous year to 35% in 2020.

In light of these trends, Alexander and his colleagues sought to determine whether the surge in telemedicine use observed among Americans compensated for the significant reduction in face-to-face medical visits.

“I wanted to understand if these reductions in face-to-face care were offset by increased use of telemedicine, and if so, whether the content of the telemedicine visit was the same as the content of the face-to-face visit.” Said.

In this study, we used the National Disease and Therapeutic Index (NDTI) as the data source. NDTI conducted by a data science company IQVIAIs an audit of practitioners across the United States and provides a continuous quote for outpatient practice in the United States.

Alexander said research access to NDTI data is a motivating factor in pursuing research. NDTI provided the authors of the study with an extraordinary level of detail on the content of both face-to-face and telemedicine visits. The data source also provided researchers with more up-to-date and timely information than many other data sources on the provision of primary care in the United States.

“This information allowed us to look back a few months ago and characterize nationally representative sample usage patterns or primary care use,” said Alexander.

According to the survey, the estimated average of quarterly primary care consultations decreased from 126.3 million in the second quarter of 2018 and 2019 to 99.3 million from April to June 2020, 21.4%. It has decreased. This decline occurred when telemedicine use surged from 1.1% of all quarterly primary care visits to 35.5% of second-quarter 2020 visits.

Amid changes in the structure of primary care delivery from direct visits to telemedicine, studies found that blood pressure and cholesterol levels were reduced by 50.1% and 36.9%, respectively, from the second quarter of 2018-2019 to 2020, respectively. did.

These findings hold an important clinical link, as checking cholesterol and blood pressure is the most important primary preventive measure for heart attacks and strokes. reading Cause of death in the United States.

Researchers also investigated the adoption rates of telemedicine between different races and ethnic groups and found that there was no significant correlation between racial / ethnic differences and the use of telemedicine.

“One of the interesting things about this is that there were no racial and ethnic differences in the adoption of telemedicine,” said Alexander. “Our findings on race and ethnicity provide one small perspective for examining complex and multifaceted scientific and public health issues.”

Alexander also highlighted the striking finding of the study that there was little correlation between the intensity of telemedicine use and the burden of COVID-19 infection in different parts of the United States.

“While the intensity of the pandemic may seem to be the main driver of telemedicine adoption, in fact, between the number of people dying from COVID in a particular area and those who may. Was found to have no statistically significant correlation. I was supposed to use telemedicine. ”

Reflecting this finding, Alexander said that other potential drivers of telemedicine adoption in different parts of the country are regional economic differences, levels of technology dissemination, technology use comfort, demographics and “Digital divide”

“As we become more dependent on telemedicine as a means of providing care, we raise concerns that we can inadvertently leave older people and people unfamiliar with technology behind,” he said.

In addition to concerns about the deterioration of the digital divide in healthcare, telemedicine poses many significant challenges for physicians and healthcare providers. One such challenge is to recreate the trust, friendliness and comfort of healthcare that is easily gained from face-to-face encounters.

In an interview with NewsletterSecond grade Shubha Verma looks back on her recent experience with telemedicine visits for mental health.

“My experience with telemedicine treatment was very poor,” she said. “My telemedicine therapist made no effort to form a connection with me. She treated in a virtual setting in the most convenient way for her, even though she did not benefit me. Designed. ”

Verma believes she would have had a better experience if the therapist made an effort to talk to her outside of therapeutic discussions.

“To be productive in therapy, it’s very important to form a connection between the client and the therapist. If she had made that effort, our session would probably have been more enjoyable,” she said. Told.

Despite the challenges posed by distance treatment, Verma still encourages others to try treatment — and don’t be afraid to switch therapists if you are inexperienced.

“Don’t hesitate to try treatment! If you don’t like the therapist after a few weeks,’break up” with the therapist and look for a new therapist, ”says Berma.

With telemedicine visits, healthcare providers also face the issue of ensuring that patients properly follow recommendations such as. Self-monitoring Their blood pressure measurement.In addition, some patients may lack what they need apparatus For effective telemedicine visits.

Alexander emphasized that public health professionals are actively working to find ways to overcome such challenges.

The question is, “What are these effects? [changes] About public health, and to what extent do they represent the optimal mode of care delivery in a pandemic? “He said. “These are questions that many wise people are working tirelessly to understand, and we hope that our research will help provide small pieces of the puzzle.”