Primary care visit trends in a public safety net health system during the COVID-19 pandemic

Little is known about access to care and telehealth trends in safety net settings during the Coronavirus-19 (COVID-19) pandemic.

We analyzed electronic health record data from patients assigned to a large, publicly funded, urban safety net system for primary care. We compared primary care visit types- in-person, telehealth (combined telephone and video visits), telephone, and video - between English-speaking patients and patients with limited English proficiency (LEP) across three study periods: pre-pandemic (March 2019-February 2020), pandemic Year 1 (March 2020-February 2021), and pandemic Year 2 (March 2021-December 2022).

Prior to the pandemic, 19% (English-speaking) and 17% (LEP) of primary care patients had a telehealth visit. This increased to 94% (English-speaking) and 95% (LEP) in Year 1 and 83% (English-speaking) and 85% (LEP) in Year 2. Over 80% of these telehealth visits were telephone visits.

Telephone visits were critical in maintaining access to primary care during the COVID-19 pandemic. Eliminating telephone visits as a billable visit could disproportionately affect underserved populations.