IMPORTANCE: Little is known about the association between the coronavirus disease 2019 (COVID-19) pandemic and the level and content of primary care delivery in the US OBJECTIVE: To quantify national changes in the volume, type, and content of primary care delivered during the COVID-19 pandemic, especially with regard to office-based vs telemedicine encounters DESIGN, SETTING, AND PARTICIPANTS: Analysis of serial cross-sectional data from the IQVIA National Disease and Therapeutic Index, a 2-stage, stratified nationally representative audit of outpatient care in the US from the first calendar quarter (Q1) of 2018 to the second calendar quarter (Q2) of 2020 MAIN OUTCOMES AND MEASURES: Visit type (office-based or telemedicine), overall and stratified by patient population and geographic region;assessment of blood pressure or cholesterol measurement;and initiation or continuation of prescription medications RESULTS: In the 8 calendar quarters between January 1, 2018, and December 31, 2019, between 122 4 million (95% CI, 117 3-127 5 million) and 130 3 million (95% CI, 124 7-135 9 million) quarterly primary care visits occurred in the US (mean, 125 8 million;95% CI, 121 7-129 9 million), most of which were office-based (92 9%) In 2020, the total number of encounters decreased to 117 9 million (95% CI, 112 6-123 2 million) in Q1 and 99 3 million (95% CI, 94 9-103 8 million) in Q2, a decrease of 21 4% (27 0 million visits) from the average of Q2 levels during 2018 and 2019 Office-based visits decreased 50 2% (59 1 million visits) in Q2 of 2020 compared with Q2 2018-2019, while telemedicine visits increased from 1 1% of total Q2 2018-2019 visits (1 4 million quarterly visits) to 4 1% in Q1 of 2020 (4 8 million visits) and 35 3% in Q2 of 2020 (35 0 million visits) Decreases occurred in blood pressure level assessment (50 1% decrease, 44 4 million visits) and cholesterol level assessment (36 9% decrease, 10 2 million visits) in Q2 of 2020 compared with Q2 2018-2019 levels, and assessment was less common during telemedicine than during office-based visits (9 6% vs 69 7% for blood pressure;P &lt; 001;13 5% vs 21 6% for cholesterol;P &lt; 001) New medication visits in Q2 of 2020 decreased by 26 0% (14 1 million visits) from Q2 2018-2019 levels Telemedicine adoption occurred at similar rates among White individuals and Black individuals (19 3% vs 20 5% of patient visits, respectively, in Q1/Q2 of 2020), varied by region (low of 15 1% of visits [East North Central region], high of 26 8% of visits [Pacific region]), and was not correlated with regional COVID-19 burden CONCLUSIONS AND RELEVANCE: The COVID-19 pandemic has been associated with changes in the structure of primary care delivery, with the content of telemedicine visits differing from that of office-based encounters
Use and Content of Primary Care Office-Based vs Telemedicine Care Visits During the COVID-19 Pandemic in the US