Patients shirked diagnostic testing, in-person preventive care amid telehealth boom this spring

• The vast majority of patients reported telemedicine visits at the start of the COVID-19 pandemic but ignored diagnostic procedures and other preventive and elective measures that can only be done in person. This is according to a study published on Thursday in the JAMA Network Open.

• The number of mammograms and colonoscopies performed in March and April decreased more than 65% year over year based on analysis of more than 5 million commercially insured patients. Overall, health care utilization decreased by 23% in March and 52% in April.

• The number of telemedicine visits increased by 4000% compared to the previous year, but only replaced about 40% of the decrease in personal visits. According to the researchers, telemedicine use in patients living in low-income or mostly non-white zip codes was about a third lower than in more affluent areas.

Telemedicine inevitably exploded when the pandemic broke out. However, providers cannot provide virtually all of their services, including routine diagnostic procedures that identify significant health problems before they progress.

“This will certainly have an impact on both patients and the provider’s delivery system,” said Christopher Whaley, lead study author and policy researcher for the lucrative RAND.

The researchers analyzed data on insurance claims from 2018 to 2020 from around 200 employers. In addition to the sharp decrease in mammograms and colonoscopies, they found that other procedures such as musculoskeletal surgeries, cataract surgeries, and MRI scans were reduced by 45% or more.

“If a younger, healthier woman misses her mammogram appointment or is several months late, she’s probably fine from a health perspective,” said Whaley. “But there are patients who have a serious problem, if the daily test is discarded, it can increase the risk of cancer or abandon simple treatment if it is caught in the head.

In-person visits to monitor chronic diseases also decreased, including blood sugar tests for diabetics, which fell more than 50 percent in March and April. Chemotherapy treatments decreased by 4%.

Vaccinations decreased by 22% in children under 2 years of age

“There need to be a truly collaborative environment between patients, providers, and payers to ensure that patients who have lost the care they need really recover,” said Whaley.

Some hospitals have turned to artificial intelligence and other technologies to better maintain routine care during COVID-19 outbreaks. Another report recently published on JAMA Network Open described how researchers found a clinical decision support tool that helps institutions better manage their resources to maintain elective courses.