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Research Roundup: Telemedicine visits up, net visits down during pandemic

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Each week, The Daily’s Science & Technology section highlights exciting and influential research happening on campus or otherwise related to Stanford. Here’s our digest for the week of Oct. 18 — Oct. 24.

Throughout the pandemic, in-person primary care visits in the United States have decreased as medical care goes virtual, but the number of remote visits has not been sufficient to make up for the difference, a Stanford Medicine study published on Oct. 2 in “JAMA Network Open” reports.

The findings suggest that there were 21% fewer visits overall during the second quarter of 2020 compared to the second quarters of 2018 and 2019.

Abha Khandelwal, a cardiovascular medicine clinical associate professor, said she has noticed this discrepancy in her practice.

“During the pandemic there has been a decrease in elective visits, and patients have delayed essential care as well,” Khandelwal wrote in a statement to The Daily. “We have noted patients wanting to delay elective procedures and routine monitoring. As a clinician, I have seen some patients very fearful of walking outside with social distancing and masks.”

As patients are less likely to visit their physician in the office, physicians are finding innovative ways to remain in touch with their patients to ensure they continually receive adequate healthcare during the pandemic.

In his own experience, study lead and medicine professor Randall Stafford approximated the current breakdown of visits at the Stanford Internal Medicine clinic to be “about 50% video visits, 40% in-person and 10% telephone.”

“I expect that this will slowly shift back towards more in-person visits, but that perhaps 25% of visits will be by video long-term,” he wrote in a statement to The Daily.

Overall in Stanford Health Care, the percentage of virtual visits is about 33% week over week, wrote Leah Rosengaus, Stanford Health Care director of digital health, in a statement to The Daily.

“There is quite a bit of variability among service lines — for example Psychiatry, Sleep Medicine, Cardiovascular Medicine and Endocrinology are almost 100% virtual, while other specialties like Gynecology, Otolaryngology, Ophthalmology are more heavily in-person.”

“In response to the COVID-19 pandemic, Stanford Health Care enabled 2,000 clinicians to provide virtual visits across all ambulatory specialties and including all of our primary care practices,” Rosengaus added.

Since March of this year, 86% of all Stanford Health Care providers offered virtual visits to their patients, and over 182,000 Stanford Health Care patients experienced their first virtual visit, according to Rosengaus. Rosengaus mentioned several benefits of virtual care, including “reduced travel time, reduced exposure risk [and] conserving personal protective equipment (PPE).”

“While virtual visits are not suitable for all conditions, when appropriate they have shown to be a safe, convenient alternative to in-person appointments,” Rosengaus wrote. “At Stanford Health Care, we are incorporating virtual care into our practice of the future, and look forward to offering new and expanded services to the community.”

Some testing procedures have declined in use during the pandemic. The research findings suggest that 50% fewer patients received blood pressure measurements, and 37% fewer patients are getting cholesterol tests. Stafford and the research team believe that the increased proportion of virtual visits likely led to the decrease in patients receiving medical tests.

As a result, many patients may begin to experience high blood pressure or an increase in cholesterol levels. For some patients, delaying these medical tests may lead to later chances of being diagnosed with diseases related to high cholesterol.

In other medical fields such as cardiovascular medicine, physicians have observed a decrease in the patients receiving speciality cardiac medical tests.

“Cardiac testing with regards to imaging had decreased over the summer, but has started to pick back up,” Khandelwal wrote. “As the COVID numbers rise, I suspect we will take another hit.” 

Cardiac patients can also face consequences of delaying speciality treatment, similarly to primary care patients. Khandelwal cited two examples she recently encountered — a patient who had a heart attack at home and another patient who had severe complications from bowel rupture.

“Less testing is not necessarily the issue, it is delay in care or treatment for cardiac or even non cardiac symptoms for fear of contracting the virus,” Khandelwal wrote. “Further, our staffing has also been impacted as we try to keep our highest risk healthcare workers out of the front lines.”

Even after the pandemic subsides, Stafford believes telemedicine virtual visits will likely remain a part of the healthcare system moving forward.

“Remote visits will become a permanent part of healthcare in the future because of both their efficiency and their convenience to patients,” Stafford wrote. “For patients with chronic diseases that benefit from regular follow-up, video visits provide a useful tool for maintaining high quality care. This is especially true for older patients with mobility problems or those patients who live far from their primary care physician.”

Stafford added that this is not a permanent solution, and healthcare will need to eventually see a shift back to in-person visits.

“However, we will need to find an optimal mix of in-person and video visits for different clinical conditions, which we are still working on. Relying solely on video visits would not be effective,” Stafford wrote.

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