Telemedicine vs in Office: How did People Manage their Hemoglobin A1C Testing During COVID?

Telehealth or Telemedicine appointments offer tremendous value to many stakeholders, based upon the results of this JAMA study in the diabetic population. Based upon review of 521 234 outpatient encounters during the study period, 63 722 met inclusion criteria. Rates of office-only HbA_1c laboratory test completion decreased from the 3-year historical prepandemic average of 74.2% to 60.2% during the pandemic. There was a 4.2% higher laboratory test adherence for office encounters compared with telemedicine visits during the pandemic—for all-specialties, all patients (60.2% vs 56.0%, P < .001). Patients with diabetes had a 7.9% laboratory test higher adherence with office visits compared to telemedicine visits (68.1% vs 60.2%, P < .001); there was no difference between office and telemedicine visits in laboratory test adherence rates for patients without diabetes (0.4%, P = .64). Overall, they found statistically significantly higher rates of HbA_1c adherence in office visits compared with telemedicine encounters during the COVID-19 pandemic. They also found moderately higher rates of HbA_1c adherence for diabetic patients in office vs telemedicine encounters. This may be due to diabetic patients understanding the value of HbA_1c testing, that the offices they visited had on-site laboratory tests or point-of-care testing, or the culture of specialty care (where high demand to see clinicians might foster an environment of health literacy). Regardless, the use of National Quality Forum’s standardized measure suggests that quality of diabetes care is close to that of in-office visits. One notable finding was no difference in adherence rates for patients without diabetes who had telemedicine encounters. This demonstrates the benefit of telemedicine in preventive care—comparable quality with lower cost. Similar to recent literature, during the pandemic, telemedicine met a care demand in our study; but moving forward, telemedicine may be a valuable care venue, especially in primary care.