New research from the Smidt Heart Institute shows that more patients, specifically those with medical risk factors or from underserved communities, opted for telehealth appointments for their cardiovascular care during the COVID-19 pandemic. The data also suggest that these telehealth patients underwent fewer diagnostic tests and received fewer medications than patients who saw their doctors in person.
The findings, published in JAMA (Journal of the American Medical Association) Open network, point to “digital changes” in cardiovascular care amid the ongoing COVID-19 pandemic.
He encouraged us to know that access to cardiovascular care was maintained for high-risk and underserved communities during the pandemic. That same study, however, identified some differences in attention that we need to deepen to better understand. “
Joseph Ebinger, MD, director of Clinical Analysis, Smidt Heart Institute and lead author of the study
The researchers examined data collected from 87,182 pre-COVID visits, 74,498 COVID-era face-to-face visits, 4,720 COVID-era telehealth visits, and 10,381 COVID-era phone visits.
In all categories, patients accessing remote visits from the COVID era were more likely to come from racial or ethnic groups, had private insurance, and had cardiovascular conditions such as hypertension, coronary artery disease, atrial fibrillation, and insufficiency. cardiac.
The researchers compared how often medications or follow-up tests were requested, including electrocardiograms and echocardiograms. The findings suggest a decrease compared to previous visits to COVID.
“Our data reveal a reduced rate of testing and prescription, probably due to a number of factors,” Ebinger said. “We see that these results are obviously not negative or positive, but a trend that is important to understand. For example, lower test and prescription rates may reflect, in many cases, reductions in care rates that are not really needed to achieving good health outcomes while adding costs to the system. “
Advantages and pitfalls of telehealth
Researchers say one of the key benefits of telecare visits is access to a remote cardiologist, which is vital for people who can’t; or they don’t want to; traveling for care due to concerns about exposure to the virus, lack of transportation, increased family demands, or inability to take time off. Without telecare visits, Ebinger said, many of these patients may not have received any health care.
But researchers also point to the importance of recognizing the possible pitfalls of telehealth services, many of which disproportionately affect communities of color.
“Because it is a relatively new platform for both patients and providers, there is a telehealth learning curve, both technically and in terms of comfort and confidence,” said Susan Cheng, MD, MPH, MMSc, Associate professor in the Department of Cardiology at Cedars-Sinai. , director of the Healthy Aging Research Institute of the Department of Cardiology at Smidt Heart Institute, and author of the study.
As an example, Cheng points out that patients must have access to a device that allows them to connect with their provider. Likewise, patients need to be comfortable with the telehealth platform and feel confident about how to access and use it effectively.
Despite the challenges of telehealth, there are conveniences as well. Researchers say previous reports have indicated that minority and racial populations constitute a disproportionate size of the essential labor market. Workers ’basic schedules have been even more intense during the pandemic, making it more difficult to adjust to a face-to-face medical appointment during regular work hours. This factor could have contributed to higher rates of telehealth use among ethnic and racial minority patients.
As a next step, researchers plan to determine whether changes in physicians ’practices during the pandemic will lead to changes in patient outcomes.
“We plan to examine below whether the order of fewer tests, such as stress tests, could predispose to missed diagnoses,” Ebinger said. “To understand the balance of risks and benefits, we are also investigating whether the lower number of ordered trials could really represent opportunities to streamline certain types of care that did not contribute significantly to health in the previous system of face-to-face visits only. “.
Yuan, N., et al. (2021) Patient use patterns and clinical practice of remote cardiology clinical visits in the COVID-19 era. JAMA network open. doi.org/10.1001/jamanetworkopen.2021.4157.