Key Points Question Is there a quantifiable association between the coronavirus disease 2019 (COVID-19) pandemic and the volume, type, and content of primary care encounters in the US? Findings In this cross-sectional analysis of the US National Disease and Therapeutic Index audit of more than 125.8 million primary care visits in the 10 calendar quarters between quarter 1 of 2018 and quarter 2 of 2020, primary care visits decreased by 21.4% during the second quarter of 2020 compared with the average quarterly visit volume of the second quarters of 2018 and 2019. Evaluations of blood pressure and cholesterol levels decreased owing to fewer total visits and less frequent assessment during telemedicine encounters. Meaning The COVID-19 pandemic was associated with changes in the structure of primary care delivery during the second quarter of 2020, with the content of telemedicine visits differing from that of office-based encounters.

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Background Four direct oral anticoagulants (DOACs) have been brought to market for the treatment of nonvalvular atrial fibrillation and venous thromboembolism. Many forces, including numerous positive trial results, emerging safety concerns, marketing and promotion may shape DOAC adoption by providers. However, relatively little is known regarding their ambulatory utilization compared with warfarin, as well as the degree to which they have decreased undertreatment of atrial fibrillation. Method We used the IMS Health National Disease and Therapeutic Index, a nationally representative audit of outpatient office visits, to estimate the use of warfarin and DOACs between 2009 and 2014. Results Overall, visits with anticoagulation use increased from 2.05 (95% CI 1.82-2.27) to 2.83 (95% CI 2.49-3.17) million (M) quarterly visits (p<0.001). Of these, DOAC use has grown to 4.21M (95% CI 3.63M-4.79M; 38.2% of total) treatment visits in 2014 since their introduction in 2010. Use of all oral anticoagulants in treatment visits for atrial fibrillation has increased from 0.88M (95% CI 0.74M-1.02M) to 1.72M (95% CI 1.47M -1.97M; p<0.001), with similar DOAC and warfarin use in 2014. Atrial Fibrillation visits with anticoagulant use increased from 51.9% (95% CI 50.4%-53.8%) to 66.9% (95% CI 65.0%-69.3%) between 2009 and 2014 (p<0.001). In 2014, rivaroxaban was the most commonly prescribed DOAC for atrial fibrillation (47.9% of office visits), followed by apixaban (26.5%) and dabigatran (25.5%). Conclusions DOACs have been rapidly adopted, matching the use of warfarin, and are associated with increased use of oral anticoagulation for patients with atrial fibrillation.