Top Changes in the Medical Field Due to COVID-19

The COVID-19 pandemic has largely been touted as an “unprecedented” time, and with good reason. And with unprecedented times come unprecedented solutions. Family gatherings, fitness classes, and even many jobs were confined to a square Zoom screen. Birthday parties were swapped for drive-by parades. Hugs and kisses took time off for a socially distanced wave of the hand or an elbow bump.

Despite all of these disruptions to “normal” life, perhaps the most significant changes at all rattled the medical world. Hopefully, some of these new adaptations are here to stay. This article goes into detail about two of the most significant things that must change in the future: telemedicine utilization and nursing homes.

Telemedicine: The Ins and Outs

The number one, most obvious change—one that healthcare providers and patients alike have perhaps enjoyed and benefitted from—is telemedicine.

At the height of the pandemic, COVID-19 “hot spots” shut down elective surgeries. Non-emergent care was postponed. Patients who didn’t have to come into the office were urged to stay home.

But what exactly did this look like? A JAMA Network Open analysis shed some light on the numbers, as well as what perhaps didn’t quite translate into telemedicine.

Researchers examined data from the IQVIA National Disease and Therapeutic Index from the first calendar quarter (Q1) of 2018 to the second calendar quarter (Q2) of 2020. Three main outcomes were considered:

• Visit type—office-based versus telemedicine—both overall and separately analyzed by patient population and geographic region
• Assessment of blood pressure or cholesterol
• Initiation or continuation of prescription medications

From Jan. 1, 2018, through Dec. 31, 2019 (eight calendar quarters), there were between 122.4 million and 130.3 million quarterly primary care visits in the U.S.; 92.9% were office-based. Quarterly numbers sharply dropped in 2020, with decreases observed as early as Q1, during which total encounters went down to 117.9 million; during Q2 of 2020, this dropped to 99.3 million—a 21.4% decrease compared to 2018 and 2019 visits during the same time period. A decrease of 50.2% in office-based visits was observed in Q2 of 2020 compared with Q2 2018 and 2019, but a significant uptick was observed in telemedicine visits. During Q2 2018 and 2019, 1.1% of visits were telemedicine; this increased to 4.1% in Q1 of 2020 and 35.3% in Q2 of 2020.

But Here’s What We Aren’t Seeing…

Although telemedicine visits were clearly on the rise, not all aspects of care carried over. Aside from the obvious things that cannot be done over a screen—such as surgeries—during Q2 of 2020, compared to Q2 of 2018 and 2019, blood pressure level assessments decreased by 50.1%, and cholesterol level assessments decreased by 36.9%. Blood pressure assessments were significantly less common during telemedicine visits than office-based visits (9.6% vs. 69.7%), as were cholesterol assessments, although to a less significant degree (13.5% vs. 21.6%). There was also a significant decrease (26%) in new medication visits during Q2 of 2020 compared to Q2 2018 and 2019.

The study authors noted no significant differences in telemedicine adoption between White and Black patients during Q1 and Q2 of 2020 (19.3% vs. 20.5% of patient visits, respectively), or differences based on regional COVID-19 burden. However, differences were observed by region, with a low of 15.1% of visits in the East North Central region, compared to a high of 26.8% of visits in the Pacific region.

Nursing Homes: Concerns Existed Before COVID-19

Nursing homes and assisted living facilities have been placed under a microscope during the pandemic, and with good reason—they house some of the nation’s most vulnerable patients. It’s already known that the elderly are more vulnerable to COVID-19 and its associated complications, regardless of whether they live in a facility or at home. Disturbingly, though, these facilities made up roughly 42% of COVID-19 deaths nationwide—despite the fact that less than 1% of the U.S. population lives in one.

It’s worth noting that nursing homes and assisted living facilities have been a cause of concern long before COVID-19 was around. An article published in Clinical Infectious Diseases in 2010—a full decade before a global pandemic was on anyone’s mind—highlighted some of the reasons why nursing home residents are more vulnerable to infectious diseases.

One problem is the grouped living dynamic—housing a large group of people under one roof. (This risk isn’t limited to the elderly, though—college campuses have also become COVID-19 hotspots.) Additional factors include:

• Changes in adaptive and innate immunity, associated with increasing age. This may make certain vaccines less effective, including the flu shot, as well as put residents at an increased risk for certain infections and reactivation of latent infections
• Multiple comorbid diseases, such as diabetes and chronic obstructive pulmonary disease
• The need for prosthetic devices, such as joint prostheses and implantable cardiac devices
• Empiric antibiotics may increase the risk for future infections caused by antibiotic-resistant pathogens

So what will the future of nursing homes look like? If possible, families may look for different solutions entirely, such as live-in health aides or living with a family member.

Billy Tauzin, former Republican congressman from Louisiana and former president of PhRMA, predicted in an interview with STAT, “I think there’s going to be a major shift in terms of support for the nursing care industry in America, and toward home care. The notion that seniors would prefer to be in their homes has always been around.”

Since these may not be feasible options for everyone, the alternative solution looking ahead is making improvements to nursing homes and assisted living facilities, which were ill-equipped to financially handle the pandemic.

An article published in The New England Journal of Medicine outlined three strategies to implement in order to improve nursing homes:

Funding. It is up to Medicaid to invest more money in these facilities. Long-term care homes are not receiving as much aid in comparison to their utilization—meaning that families are often taking either the financial burden or the responsibility of providing care themselves.

Improved options. The authors acknowledged that this would require a significant financial undertaking but noted that recent events have proven how crucial it is. They called for residential alternatives that house fewer residents.

Revamp the system. It may be time to reconsider the current financial model. The researchers recommend, “More comprehensive funding through existing social insurance programs or stand-alone universal long-term care insurance for the entire population … could provide a better model that values long-term care.”