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Patient Use and Clinical Practice Patterns of Remote Cardiology Clinic Visits in the Era of COVID-19.
Yuan, Neal; Pevnick, Joshua M; Botting, Patrick G; Elad, Yaron; Miller, Shaun J; Cheng, Susan; Ebinger, Joseph E.
  • Yuan N; Smidt Heart Institute, Cedars-Sinai Medical Center, Los Angeles, California.
  • Pevnick JM; Department of Medicine, Cedars-Sinai Medical Center, Los Angeles, California.
  • Botting PG; Division of Informatics, Department of Biomedical Sciences, Cedars-Sinai Medical Center, Los Angeles, California.
  • Elad Y; Smidt Heart Institute, Cedars-Sinai Medical Center, Los Angeles, California.
  • Miller SJ; Smidt Heart Institute, Cedars-Sinai Medical Center, Los Angeles, California.
  • Cheng S; Division of Informatics, Department of Biomedical Sciences, Cedars-Sinai Medical Center, Los Angeles, California.
  • Ebinger JE; Department of Medicine, Cedars-Sinai Medical Center, Los Angeles, California.
JAMA Netw Open ; 4(4): e214157, 2021 04 01.
Article in English | MEDLINE | ID: covidwho-1168796
ABSTRACT
Importance The COVID-19 pandemic has led to an unprecedented shift in ambulatory cardiovascular care from in-person to remote visits.

Objective:

To understand whether the transition to remote visits is associated with disparities in patient use of care, diagnostic test ordering, and medication prescribing. Design, Setting, and

Participants:

This cross-sectional study used electronic health records data for all ambulatory cardiology visits at an urban, multisite health system in Los Angeles County, California, during 2 periods April 1, 2019, to December 31, 2019 (pre-COVID) and April 1 to December 31, 2020 (COVID-era). Statistical analysis was performed from January to February 2021. Exposure In-person or remote ambulatory cardiology clinic visit at one of 31 during the pre-COVID period or COVID-era period. Main Outcomes and

Measures:

Comparison of patient characteristics and frequencies of medication ordering and cardiology-specific testing across 4 visit types (pre-COVID in-person (reference), COVID-era in-person, COVID-era video, COVID-era telephone).

Results:

This study analyzed data from 87 182 pre-COVID in-person, 74 498 COVID-era in-person, 4720 COVID-era video, and 10 381 COVID-era telephone visits. Across visits, 79 572 patients were female (45.0%), 127 080 patients were non-Hispanic White (71.9%), and the mean (SD) age was 68.1 (17.0) years. Patients accessing COVID-era remote visits were more likely to be Asian, Black, or Hispanic individuals (24 934 pre-COVID in-person visits [28.6%] vs 19 742 COVID-era in-person visits [26.5%] vs 3633 COVID-era video visits [30.4%] vs 1435 COVID-era telephone visits [35.0%]; P < .001 for all comparisons), have private insurance (34 063 pre-COVID in-person visits [39.1%] vs 25 474 COVID-era in-person visits [34.2%] vs 2562 COVID-era video visits [54.3%] vs 4264 COVID-era telephone visits [41.1%]; P < .001 for COVID-era in-person vs video and COVID-era in-person vs telephone), and have cardiovascular comorbidities (eg, hypertension 37 166 pre-COVID in-person visits [42.6%] vs 31 359 COVID-era in-person visits [42.1%] vs 2006 COVID-era video visits [42.5%] vs 5181 COVID-era telephone visits [49.9%]; P < .001 for COVID-era in-person vs telephone; and heart failure 14 319 pre-COVID in-person visits [16.4%] vs 10 488 COVID-era in-person visits [14.1%] vs 1172 COVID-era video visits [24.8%] vs 2674 COVID-era telephone visits [25.8%]; P < .001 for COVID-era in-person vs video and COVID-era in-person vs telephone). After adjusting for patient and visit characteristics and in comparison with pre-COVID in-person visits, during video and telephone visits, clinicians had lower odds of ordering any medication (COVID-era in-person odds ratio [OR], 0.62 [95% CI, 0.60-0.64], COVID-era video OR, 0.22 [95% CI, 0.20-0.24]; COVID-era telephone OR, 0.14 [95% CI, 0.13-0.15]) or tests, such as electrocardiograms (COVID-era in-person OR, 0.60 [95% CI, 0.58-0.62]; COVID-era video OR, 0.03 [95% CI, 0.02-0.04]; COVID-era telephone OR, 0.02 [95% CI, 0.01-0.03]) or echocardiograms (COVID-era in-person OR, 1.21 [95% CI, 1.18-1.24]; COVID-era video OR, 0.47 [95% CI, 0.42-0.52]; COVID-era telephone OR, 0.28 [95% CI, 0.25-0.31]). Conclusions and Relevance Patients who were Asian, Black, or Hispanic, had private insurance, and had at least one of several cardiovascular comorbidities used remote cardiovascular care more frequently in the COVID-era period. Clinician ordering of diagnostic testing and medications consistently decreased when comparing pre-COVID vs COVID-era and in-person vs remote visits. Further studies are needed to clarify whether these decreases represent a reduction in the overuse of tests and medications vs an underuse of indicated testing and prescribing.
Subject(s)

Full text: Available Collection: International databases Database: MEDLINE Main subject: Practice Patterns, Physicians&apos; / Cardiology / Patient Acceptance of Health Care / Telemedicine / Pandemics / Ambulatory Care / COVID-19 Type of study: Diagnostic study / Observational study / Prognostic study / Randomized controlled trials Limits: Aged / Female / Humans / Male / Middle aged Language: English Journal: JAMA Netw Open Year: 2021 Document Type: Article

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Full text: Available Collection: International databases Database: MEDLINE Main subject: Practice Patterns, Physicians&apos; / Cardiology / Patient Acceptance of Health Care / Telemedicine / Pandemics / Ambulatory Care / COVID-19 Type of study: Diagnostic study / Observational study / Prognostic study / Randomized controlled trials Limits: Aged / Female / Humans / Male / Middle aged Language: English Journal: JAMA Netw Open Year: 2021 Document Type: Article