The Rise of Telehealth in Primary Practice and Its Effect on Clinical Results During COVID-19
DOI:
https://doi.org/10.5281/zenodo.20443539Keywords:
Telehealth; primary care; COVID-19; outcomes; telemedicine; video visits; telephonic visits; chronic disease management; preventive care; safety; quality; acute care; patient-centeredness; equity; technology use.Abstract
The COVID-19 pandemic precipitated a rapid shift to virtual service delivery in the United States, with telehealth adoption soaring across clinical specialties, patient conditions, and visit types. Nevertheless, evidence supporting telehealth’s effectiveness in primary care remains limited, especially for acute and preventive services. This study tested telehealth adoption and clinical outcomes across 54 primary care clinics affiliated with a single health system in the diverse, urban, and often low-income environment of Los Angeles County. Hierarchical multivariable models assessed clinical outcomes for 27 chronic disease cohorts, along with rates of acute care visits, preventive services, and safety events.
The results indicated associations between elevated telehealth use and reduced utilization of in-person services for acute conditions such as respiratory infections, without negative effects on quality or patient-reported outcomes. Findings suggest that telehealth can facilitate quality primary care for well-defined conditions despite relatively low-volume adoption, and may serve as an effective adjunct to in-person care for preventive, chronic, acute, and mental health needs. Though telehealth is not a panacea, the evidence, when viewed in aggregate, supports its nuanced deployment as a patient-centered alternative within the wider multichannel service portfolio.
References
[1] Al Ammari, M., Sultana, K., Al-Gaai, E. A., Al-Saleh, A., Albalawi, I., Al-Mubarak, H., & Alomi, Y. A. (2021). Tele-pharmacy anticoagulation clinic during COVID-19 pandemic: Patient outcomes and satisfaction. Frontiers in Pharmacology, 12, 652482. doi:10.3389/fphar.2021.652482
[2] Cannon, P., & Hardwick, A.. An innovative and authentic way of learning how to consult remotely in primary care. Education for Primary Care, 33(2), 116–118. doi:10.1080/14739879.2021.1920476
[3] Chin, M. H. (2021). What COVID-19 has revealed about chronic-disease care in the United States. The New England Journal of Medicine, 385(18), 1633–1636. doi:10.1056/NEJMp2112063
[4] DePuccio, M. J., Farrell, C. L., Hoffman, M. R., Desai, A. V., & Forrest, C. B. (2021). Making it work: Physicians’ perspectives on the rapid transition to telemedicine during the COVID-19 pandemic. Telemedicine and e-Health, 27(12), 1354–1361. doi:10.1089/tmj.2020.0526
[5] Der-Martirosian, C., Chu, K., Dobalian, A., & Gagnon, D. R.. Examining telehealth use among primary care patients during the COVID-19 pandemic. BMC Primary Care, 23, 146. doi:10.1186/s12875-022-01751-1
[6] Doraiswamy, S., Jithesh, A., Mamtani, R., Abraham, A., & Cheema, S. (2020). Use of telehealth during the COVID-19 pandemic: Scoping review. Journal of Medical Internet Research, 22(12), e24087. doi:10.2196/24087
[7] Eberly, L. A., Kallan, M. J., Julien, H. M., Haynes, N., Khatana, S. A. M., Nathan, A. S., … Frankel, D. S. (2020). Patient characteristics associated with telemedicine access for primary and specialty ambulatory care during the COVID-19 pandemic. JAMA Network Open, 3(12), e2031640. doi:10.1001/jamanetworkopen.2020.31640
[8] Frank, H. E., Grumbach, N. M., Conrad, S. M., Wheeler, J., & Wolff, J. C. (2021). Mental health services in primary care: Evidence for the feasibility of telehealth during the COVID-19 pandemic. Journal of Affective Disorders Reports, 5, 100146. doi:10.1016/j.jadr.2021.100146
[9] Hernández-Galdamez, D., Mansilla, K., Peralta, A. L., Rodríguez-Szászdi, J., Ramírez, J. M., Roche, D., … Fort, M. P. (2021). Monitoring study participants and implementation with phone calls to support hypertension control during the COVID-19 pandemic: The case of a multicomponent intervention trial in Guatemala. Global Heart, 16(1), 77. doi:10.5334/gh.1065
[10] Hsueh, L., Huang, J., Millman, A. K., Gopalan, A., Parikh, R. K., Teran, S., … Borne, R. T. (2021). Disparities in use of video telemedicine among patients with limited English proficiency during the COVID-19 pandemic. JAMA Network Open, 4(11), e2133129. doi:10.1001/jamanetworkopen.2021.33129
[11] Khoshrounejad, F., Hamednia, M., Mehrjerd, A., Pichaghsaz, S., Jamalirad, H., Sargolzaei, M. S., … Aalaei, S. (2021). Telehealth-based services during the COVID-19 pandemic: A systematic review of features and challenges. Frontiers in Public Health, 9, 711762. doi:10.3389/fpubh.2021.711762
[12] Koonin, L. M., Hoots, B., Tsang, C. A., Leroy, Z., Farris, K., Jolly, B., … Harris, A. M. (2020). Trends in the use of telehealth during the emergence of the COVID-19 pandemic—United States, January–March 2020. MMWR. Morbidity and Mortality Weekly Report, 69(43), 1595–1599. doi:10.15585/mmwr.mm6943a3
[13] Lam, K., Lu, A. D., Shi, Y., & Covinsky, K. E. (2020). Assessing telemedicine unreadiness among older adults in the United States during the COVID-19 pandemic. JAMA Internal Medicine, 180(10), 1389–1391. doi:10.1001/jamainternmed.2020.2671
[14] Lin, J. C., & Kavousi, Y. (2021). COVID-19 and vascular disease: Telemedicine platforms and their impact on chronic disease management. Journal of Vascular Surgery, 73(1), 326–331. doi:10.1016/j.jvs.2020.07.102
[15] Mehrotra, A., Chernew, M., Linetsky, D., Hatch, H., & Cutler, D. (2021). The impact of the COVID-19 pandemic on outpatient visits: A rebound emerges. The Commonwealth Fund. (Research brief)
[16] Monaghesh, E., & Hajizadeh, A. (2020). The role of telehealth during COVID-19 outbreak: A systematic review based on current evidence. BMC Public Health, 20, 1193. doi:10.1186/s12889-020-09301-4
[17] Payan, D. D., Rodriguez, H. P., & Weech-Maldonado, R.. Telemedicine implementation and use in community health centers during COVID-19: A mixed-methods study. JAMIA Open, 5(2), ooac038. doi:10.1093/jamiaopen/ooac038
[18] Patel, S. Y., Mehrotra, A., Huskamp, H. A., Uscher-Pines, L., Ganguli, I., & Barnett, M. L. (2021). Trends in outpatient care delivery and telemedicine during the COVID-19 pandemic in the US. JAMA Internal Medicine, 181(3), 388–391. doi:10.1001/jamainternmed.2020.5928
[19] Patel, S. Y., Rose, S., Barnett, M. L., Huskamp, H. A., Uscher-Pines, L., & Mehrotra, A. (2021). Community factors associated with telemedicine use during the COVID-19 pandemic. JAMA Network Open, 4(5), e2110330. doi:10.1001/jamanetworkopen.2021.10330
[20] Patel, S. Y., Mehrotra, A., Huskamp, H. A., Uscher-Pines, L., Ganguli, I., & Barnett, M. L. (2021). Variation in telemedicine use and outpatient care during the COVID-19 pandemic in the United States. Health Affairs, 40(2), 349–358. doi:10.1377/hlthaff.2020.01786
[21] Powers, B. W., Rinefort, S., & Jain, S. H. (2021). Primary care payment model and telemedicine use for Medicare Advantage enrollees during the COVID-19 pandemic. JAMA Health Forum, 2(6), e211097. doi:10.1001/jamahealthforum.2021.1097
[22] Rodriguez, J. A., Betancourt, J. R., Sequist, T. D., & Ganguli, I. (2021). Differences in the use of telephone and video telemedicine visits during the COVID-19 pandemic. The American Journal of Managed Care, 27(1), 21–26. doi:10.37765/ajmc.2021.88573
[23] Schifeling, C. H., Shanbhag, P., Johnson, A., Atwater, R. C., Koljack, C., Parnes, B. L., … Farber, N. J. (2020). Disparities in video and telephone visits among older adults during the COVID-19 pandemic: Cross-sectional analysis. JMIR Aging, 3(2), e23176. doi:10.2196/23176
[24] Taylor, P., Berg, C., Thompson, J., Dean, K., Yuan, T., Nallamshetty, S., & Tong, I.. Effective access to care in a crisis period: Hypertension control during the COVID-19 pandemic by telemedicine. Mayo Clinic Proceedings: Innovations, Quality & Outcomes, 6(1), 19–26. doi:10.1016/j.mayocpiqo.2021.11.006
[25] Thomas-Jacques, T., Jamieson, T., & Shaw, J. (2021). Telephone, video, equity and access in virtual care. npj Digital Medicine, 4, 150. doi:10.1038/s41746-021-00528-y
[26] Uscher-Pines, L., Sousa, J., Raja, P., Mehrotra, A., Barnett, M. L., & Huskamp, H. A. (2021). Suddenly becoming a “virtual doctor”: Experiences of psychiatrists transitioning to telemedicine during the COVID-19 pandemic. Psychiatric Services, 72(10), 1143–1150. doi:10.1176/appi.ps.202000250
[27] Venkatesh, K. P., Mehrotra, A., & Huskamp, H. A.. Has increased telehealth access during COVID-19 led to overuse? npj Digital Medicine, 5, 177. doi:10.1038/s41746-022-00740-4
[28] Vogt, E. L., Welch, B. M., Bunnell, B. E., Barrera, J. F., Paige, S. R., & Kaphingst, K. A.. Quantifying the impact of COVID-19 on telemedicine utilization: Retrospective observational study. Interactive Journal of Medical Research, 11(1), e29880. doi:10.2196/29880
[29] Wosik, J., Fudim, M., Cameron, B., Gellad, Z. F., Cho, A., Phinney, D., … Katz, J. N. (2020). Telehealth transformation: COVID-19 and the rise of virtual care. Journal of the American Medical Informatics Association, 27(6), 957–962. doi:10.1093/jamia/ocaa067
[30] Ye, S., Kronish, I., Fleck, E., & Horowitz, C.. The impact of telemedicine visits on controlling high blood pressure: Retrospective cohort study. JMIR Formative Research, 6(3), e32403. doi:10.2196/32403
[31] Zhang, Y., Arora, P., Fu, J., & Zhang, Y.. Impact of telehealth on health care resource utilization during the COVID-19 pandemic: A real-world analysis. Journal of Comparative Effectiveness Research, 11(9), 677–687. doi:10.2217/cer-2021-0242
Additional Files
Published
Data Availability Statement
The paper identifies its data sources as: (1) the CDC's COVID-19 Research Database (EHR and Multiple Source Data Resource Center), (2) U.S. commercial and Medicare Advantage insurance claims for enrollees aged 18–65, and (3) patient-level sociodemographic data from clinic records — but does not specify whether these datasets are publicly accessible or available upon request.
