Seeing a doctor can be crucial to managing and preventing chronic disease but there has long been a racial gap in routine visits that can't be explained by racism or income. 

Maybe people didn't like like going to the doctor because the COVID-19 pandemic caused use of telemedicine to rise sharply, and as that happened gaps in visits disappeared for black patients at Penn Medicine. 

Once “normal” in-office appointments returned, previous inequities stayed erased, indicating that telemedicine wasn’t just a stopgap solution but a potential long-term tool for equity. 

COVID-19’s onset in early 2020 resulted in a telemedicine boom. Use of it had typically been narrow, largely due to government regulations, but emergency provisions allowed health care entities to quickly conduct appointments via phone or computer. Concerns that telemedicine might adversely impact racial and ethnic groups are why the authors of the new paper decided to focus on whether black patients at Philadelphia-area practices were able to see their primary care providers as often in 2020 as they had in 2019, and then compare those numbers to non-Black patients which, in their population, mainly consists of white, non-Hispanic people.

Data from roughly 1 million appointments in each year were analyzed and showed that completed primary care visits rose from approximately 60 percent among black patients before the arrival of COVID-19 to over 80 percent in 2020. To compare, white patient visit completion was in the 70 percent range prior to COVID-19, then was also over 80 percent in 2020. 

Overall, raw totals indicated that completed primary care visits declined in 2020 compared to 2019, which wasn’t unexpected due to infection control-related shutdowns and general hesitancy among the public to be seen in-person. It also was not unexpected that the numbers of completed appointments via telemedicine would rise in 2020 compared to the year before. This happened exponentially: In 2019, among the million total visits studied, completed telemedicine appointments were in just the double digits. In 2020, these telemedicine appointments were in the six-figure range.

Data also showed that, proportionately, black patients took part in telemedicine much more often than white patients. Roughly 33 percent of black patients’ 2020 appointments were completed via telemedicine, with 25 percent occurring via telemedicine for others. Rates for both were below a tenth of a percent the year before.

But the researchers sought to get a closer look at how visits trended over 2020, so they split the years they studied up into four distinct time periods based on 2020’s events: Pre-pandemic (January until March 12, largely before COVID-19 struck the Philadelphia area); Shutdown (March 13 until June 3, when stay-at-home orders were largely in place); Re-opening (June 4 through September, when stay-at-home orders were mostly lifted); and Second Wave (October through December, when COVID-19 cases began to surge again).

 The Shutdown period showed the starkest changes compared to 2019. Completed visits dropped for black patients during that period in 2020 by roughly 8 percent, but other patients’ visit completion rates fell precipitously, by 20 percent. After that, other rates returned to their regular 2019 averages, while black patients’ rates climbed dramatically (to 7 and 8 percent above their 2019 levels) in the two time periods following. The argument could be made that more people sought medical attention in 2020 due to COVID-19’s presence. But analyses showed that while visits during the Shutdown period were largely tied to concerns about COVID-19, the visits in the latter half of 2020 involved concerns that closely resembled visits in 2019.

“Telemedicine allowed patients to seek non-urgent primary care despite hesitancy for in-person visits pre-vaccine,” said study co-author Corinne Rhodes, MD, an assistant professor of Internal Medicine and assistant medical director of Quality in Penn Medicine’s Primary Care Service Line. “Providing chronic disease management and preventive care helped return primary care offices closer to pre-pandemic business as usual.”