• Ariel Chen

Evaluations of Cardiovascular Risk Factors Fall as Telehealth Skyrockets

Despite the surge in telemedicine, the number of primary care visits has fallen since the Covid-19 public health emergency — and so has screening for cardiovascular risk factors, according to an analysis of serial cross-sectional data.

A basic health screening is performed whenever you go to an in-office doctor appointment. Adult patients’ overall wellness is usually evaluated by blood pressure, weight, and medical history review. Since COVID-19 hit this year, blood oxygen and body temperature are added to the basic health screening for each in-office visit. You may not be aware of its importance, but physicians use such screenings to check for underlying health conditions before symptoms are evident.

However, while the volume of virtual visits skyrocketed, the quality of those visits did not necessarily keep pace — particularly for patients with chronic illnesses who rely on regular evaluations of blood pressure and cholesterol. This shortcoming reflects problems that were beginning to snowball before the crisis unfolded. For example, patients have traditionally been pushed to come into the office because clinicians were reimbursed at a lower rate for virtual visits. This has meant that many patients — particularly those who face existing barriers to care, such as difficulties with transportation to and from the office — may likely have missed out on having the readings taken altogether.

A new study from a team of Johns Hopkins and Stanford researchers offers an early insight into the quality of telehealth visits during the pandemic at a time when most studies have only looked at quantity.

  1. Primary care consultations declined by 21.4% percent during the second quarter of 2020, compared with average second-quarter volumes in 2018 and 2019.

  2. Roughly 70% of office-based primary care visits in the second quarter of 2020 had a blood pressure recording, compared to just under 10% of telemedicine visits. It suggests that telemedicine — at least in its current form — may be ill-suited to staunch the collateral health effects of the pandemic, such as a rise in heart attacks and strokes among patients with chronic conditions.

Patients with cardiovascular related problems are underserved during telemedicine encounters. The report brought to the public eye awareness of chronic disease management and remote patient monitoring (RPM). Remote patient monitoring enables providers to serve their patients with chronic conditions such as diabetes, obesity, and congestive heart failure via cellular-connected devices and receive longitudinal data in perpetuity. The output informs a telemedicine visit and assists healthcare providers in ensuring a patient is in compliance – all without an office visit.

Remote monitoring tools such as connected blood pressure cuffs and glucose meters, along with at-home cholesterol tests, could go a long way in helping to address this problem, since they let patients test themselves anywhere, including at home. But those tools have not yet been widely adopted by physicians and patients — and while they’re gaining popularity, their uptake hasn’t kept pace with the pandemic.

Some experts said they’re also concerned that relying on remote monitoring tools might worsen existing health disparities by socioeconomic status and by race. At present, the tools are made available primarily to white-collar workers through a network of private insurance plans and employer benefits. More vulnerable populations — including people most at risk of contracting Covid-19 — rely on government plans that do not presently reimburse for many virtual tools focused on chronic disease. Besides, many of the tools require access to a personal laptop or smartphone as well as a high-speed internet connection — things many people in rural and low-income areas do not have.

Apparently, there are still many controversies around RPM and ways to improve virtual care capabilities. Contact MicMD to get more insights and solutions.