Dramatic Changes

Outpatient visits in decline during COVID-19 pandemic

A stethoscope on a case history form
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This article is part of Harvard Medical School’s continuing coverage of medicine, biomedical research, medical education and policy related to the SARS-CoV-2 pandemic and the disease COVID-19.

Outpatient care has dramatically changed in the United States during the COVID-19 pandemic. Many elective and preventative visits have been deferred and physicians are increasingly offering telemedicine visits to prevent patients from being exposed to the coronavirus.

New research by faculty in the Department of Health Care Policy in the Blavatnik Institute at Harvard Medical School and colleagues has measured the magnitude of the changes.

A report by Ateev Mehrotra, associate professor of health care policy, and Michael Chernew, the Leonard D. Schaeffer Professor of Health Care Policy, and colleagues published by The Commonwealth Fund on May 19 shows that visits to ambulatory practices declined nearly 60 percent in mid-March 2020 and remained low throughout April.

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The researchers noted that although visits have rebounded since early April, as of May 16, they remain roughly a third lower than they were before the pandemic. The rebound in provider visits is due to more in-person appointments rather than more telemedicine visits, the researchers found.

Visit rates dropped most significantly among specialty surgeries and procedures, with other specialties such as adult primary care, oncology and behavioral health seeing less significant decreases, the researchers found. Patient populations that experienced the largest decreases in in-person visits were older adults and school-age children, the study showed.

While these declines were seen across the United States, the decline was greatest in the mid-Atlantic and New England regions. Telehealth visits increased as in-person visit rates fell, with nearly 30 percent of ambulatory visits being provided via telemedicine. However, this increase was not enough to offset the decline of in-person visits entirely.