Patient Use and Clinical Practice Patterns of Remote Cardiology Clinic Visits in the Era of COVID-19

Abstract

Key Points Question Is the transition to remote cardiology ambulatory visits during the COVID-19 pandemic associated with disparities in patient access to care, ordering of diagnostic tests, and/or medication prescribing? Findings In this cross-sectional study of 176 781 ambulatory cardiology visits, patients using COVID-era remote visits were more likely to be Asian, Black, or Hispanic individuals, have private insurance, and have cardiovascular comorbidities. Compared with pre-COVID in-person visits, clinicians during COVID-era video and telephone visits had a significantly lower odds of ordering any medication as well as most tests. Meaning Remote cardiology clinic visits were used more often by certain traditionally underserved patient groups but were also associated with less frequent testing and prescribing.

Disparities in Outpatient and Telehealth Visits During the COVID-19 Pandemic in a Large Integrated Health Care Organization: Retrospective Cohort Study

“…Members living in an area with median household income <US $40,000 increased their telehealth visits per person-year from 0.82 during week 1-9 to 3.38 during week 12-16, a higher percentage increase than that for those living in an area with median household income ≥US $80,000 (from 0.92 during week 1-9 to 3.22 during week [12][13][14][15][16]. The KPSC service area covers mostly nonrural residents whose access to a telephone is not a barrier for using telehealth services.…”

“…The impact of the COVID-19 pandemic on telephone and video visits may differ because the barrier to technology use is higher for video than telephone [12]. We assessed the rate of telehealth visits within KPSC separately by telephone and video visits (Multimedia Appendix 1).…”

“…Individuals with limited digital literacy or access to digital technology, limited health literacy, or limited English proficiency may not have the means to pursue telehealth technologies [11]. During the COVID-19 pandemic, these barriers may influence the existing disparities in accessing telehealth visits among individuals of low socioeconomic status, individuals of racial and ethnic minorities, and women [12]. Knowledge about utilization disparities during the pandemic is limited, and there remains great interest in understanding utilization disparities in large and diverse health care organizations.…”

Preventing the Next Pandemic: The Case for Investing in Circulatory Health – A Global Coalition for Circulatory Health Position Paper

“…Such issues are more pronounced in low-income countries (LICs), and LMICs [43]. A second study corroborated several of these findings but also showed that providers were less likely to prescribe medicines or order diagnostic tests during telemedicine visits compared to in-person visits [44]. While the reasons for these observations are unclear, they suggest that remote cardiovascular care can contribute to or maintain care gaps and continued optimization of telemedicine delivery is needed to deliver its promise.…”

Management of Frail and Older Homebound Patients With Heart Failure: A Contemporary Virtual Ambulatory Model

“…The proportion of patients with HF unable or unwilling to physically interact with the medical system has only increased during the global COVID-19 pandemic. [5][6][7] Virtual visits using videoconferencing technology is an appealing solution, but data to support its efficacy and safety in replacing in-person visits for this patient population remain limited. Legitimate concerns persist as to the reliability of the technology, the fidelity of the virtual interaction, and the willingness of an older patient population to accept these kinds of medical interactions.…”