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Primary care visits declined dramatically after the COVID-19 public health emergency started and screenings for common cardiovascular risk factors fell sharply, cross-sectional data showed.

Despite a huge uptick in telemedicine, the overall number of primary care consultations dropped by about 21% during the second quarter of 2020, compared with average volumes during the second quarters of 2018 and 2019.

Blood pressure checks were cut in half and cholesterol tests dropped by more than one-third, reported G. Caleb Alexander, MD, of Johns Hopkins University in Baltimore, and colleagues, in .

"These are not trivial declines: they are large, clinically important declines involving two of the most fundamental elements of primary care -- the prevention of heart attacks and strokes," Alexander said in a statement.

Telemedicine is "an imperfect substitute" for many office visits and "these findings raise serious concerns regarding the collateral effects of the COVID-19 pandemic on cardiovascular disease prevention in the United States," he added.

The study used data from the National Disease and Therapeutic Index, an ongoing audit of outpatient care conducted by the market research firm IQVIA, and considered telemedicine to be either telephone or video visits.

Including telemedicine visits, primary care consultations totaled 99.3 million during April, May, and June 2020 -- a 21.4% drop from an estimated average of 126.3 million visits during the same months in 2018-2019.

Comparing primary care visits in the second quarter of 2020 with the second quarters of 2018-2019, the researchers found:

• Office-based primary care visits declined by 50.2%
• Telemedicine primary care visits jumped from 1.1% to 35.3% of total visits
• Blood pressure checks dropped by 50.1%
• Cholesterol tests fell by 36.9%
• New medication visits decreased by 26.0%

Alexander and colleagues did not find a difference in telehealth uptake between Black and white patients. Middle-age and commercially insured people were more likely to use telemedicine than others. Telemedicine use varied geographically and was not correlated with regional COVID-19 case numbers.

There's "substantial room for an optimistic reading of this analysis," observed Lisa Chew, MD, MPH, of the University of Washington in Seattle, and colleagues, in an .

"The decrease in blood pressure or cholesterol assessments during telemedicine encounters could be mitigated by focusing on reliable ways of capturing objective information at home," they wrote. "For example, if patients with hypertension had home blood pressure monitors, much as diabetic patients are equipped with tools for measuring glycemic control, hypertension would become more straightforward and practical to manage virtually."

But access to telemedicine or home monitoring tools is not available to all patients, Chew's group pointed out. Local patterns in their area, for example, showed clinics serving people who are homeless or racially diverse safety-net populations were less likely to adopt telemedicine, they noted.

"Despite implementing real-time technical support for audiovisual visits at two safety-net clinics, we still have very low rates of successful visits via an audiovisual platform," they wrote. "The most common barrier we encounter is lack of access to the necessary technology."

If substantial primary care volume continues to be delivered by telemedicine, more attention on the content and quality of virtual visits is inevitable, Alexander and colleagues noted.

"Despite findings in a demonstrating the feasibility and acceptance of telemedicine for use in primary care, to our knowledge, relatively few rigorous comparisons of clinical outcomes in office-based vs telemedicine encounters have been performed," they said. "Our finding that such visits were less likely to include blood pressure or cholesterol assessments underscores the limitation of telemedicine, at least in its current form, for an important component of primary care prevention and chronic disease management."

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