{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,10,29]],"date-time":"2026-10-29T23:47:00Z","timestamp":1793317620471,"version":"4.5.0"},"reference-count":28,"publisher":"Ovid Technologies (Wolters Kluwer Health)","issue":"3","content-domain":{"domain":["www.ahajournals.org"],"crossmark-restriction":true},"short-container-title":["JAHA"],"published-print":{"date-parts":[[2023,2,7]]},"abstract":"<jats:sec sec-type=\"background\" xml:lang=\"en\">\n            <jats:title>Background<\/jats:title>\n            <jats:p xml:lang=\"en\">Because the impact of changes in how outpatient care was delivered during the COVID\u201019 pandemic is uncertain, we designed this study to examine the frequency and type of outpatient visits between March 1, 2019 to February 29, 2020 (prepandemic) and from March 1, 2020 to February 28, 2021 (pandemic) and specifically compared outcomes after virtual versus in\u2010person outpatient visits during the pandemic.<\/jats:p>\n          <\/jats:sec>\n          <jats:sec xml:lang=\"en\">\n            <jats:title>Methods and Results<\/jats:title>\n            <jats:p xml:lang=\"en\">Population\u2010based retrospective cohort study of all 3.8\u00a0million adults in Alberta, Canada. We examined all physician visits and 30\u2010 and 90\u2010day outcomes, with a focus on those adults with the cardiovascular ambulatory\u2010care sensitive conditions heart failure, hypertension, and diabetes. Our primary outcome was emergency department visit or hospitalization, evaluated using survival analysis accounting for competing risk of death. Although in\u2010person outpatient visits decreased by 38.9% in the year after March 1, 2020 (10\u2009142\u2009184 versus 16\u2009592\u2009599 in the prior year), the introduction of virtual visits (7\u2009152\u2009147; 41.4% of total) meant that total outpatient visits increased by 4.1% in the first year of the pandemic for Albertan adults. Outpatient visit frequency (albeit 41.4% virtual, 58.6% in\u2010person) and prescribing patterns were stable in the first year after pandemic onset for patients with the cardiovascular ambulatory\u2010care sensitive conditions we examined, but laboratory test frequency declined by 20% (serum creatinine) to 47% (glycosylated hemoglobin). In the first year of the pandemic, virtual outpatient visits were associated with fewer subsequent emergency department visits or hospitalizations (compared with in\u2010person visits) for patients with heart failure (adjusted hazard ratio [aHR], 0.90 [95% CI, 0.85\u20130.96] at 30\u2009days and 0.96 [95% CI, 0.92\u20131.00] at 90\u2009days), hypertension (aHR, 0.88 [95% CI, 0.85\u20130.91] and 0.93 [95% CI, 0.91\u20130.95] at 30 and 90\u2009days), or diabetes (aHR, 0.90 [95% CI, 0.87\u20130.93] and 0.93 [95% CI, 0.91\u20130.95] at 30 and 90\u2009days).<\/jats:p>\n          <\/jats:sec>\n          <jats:sec xml:lang=\"en\">\n            <jats:title>Conclusions<\/jats:title>\n            <jats:p xml:lang=\"en\">The adoption and rapid uptake of virtual outpatient care during the COVID\u201019 pandemic did not negatively impact frequency of follow\u2010up, prescribing, or short\u2010term outcomes, and could have potentially positively impacted some of these for adults with heart failure, diabetes, or hypertension in a setting where there was an active reimbursement policy for virtual visits. Given declines in laboratory monitoring and screening activities, further research is needed to evaluate whether long\u2010term outcomes will differ.<\/jats:p>\n          <\/jats:sec>","DOI":"10.1161\/jaha.122.027922","type":"journal-article","created":{"date-parts":[[2023,2,3]],"date-time":"2023-02-03T11:27:48Z","timestamp":1675423668000},"update-policy":"https:\/\/doi.org\/10.1161\/crossmarkpolicy","source":"Crossref","is-referenced-by-count":15,"title":["Frequency and Type of Outpatient Visits for Patients With Cardiovascular Ambulatory\u2010Care Sensitive Conditions During the COVID\u201019 Pandemic and Subsequent Outcomes: A Retrospective Cohort Study"],"prefix":"10.1161","volume":"12","author":[{"ORCID":"https:\/\/orcid.org\/0000-0001-7435-3341","authenticated-orcid":false,"given":"Finlay A.","family":"McAlister","sequence":"first","affiliation":[{"name":"Division of General Internal Medicine, Faculty of Medicine and Dentistry University of Alberta Edmonton Alberta Canada"},{"name":"Alberta Strategy for Patient Oriented Research Support Unit Edmonton Alberta Canada"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0003-4441-4216","authenticated-orcid":false,"given":"Zoe","family":"Hsu","sequence":"additional","affiliation":[{"name":"Alberta Strategy for Patient Oriented Research Support Unit Edmonton Alberta Canada"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0001-8200-1012","authenticated-orcid":false,"given":"Yuan","family":"Dong","sequence":"additional","affiliation":[{"name":"Alberta Strategy for Patient Oriented Research Support Unit Edmonton Alberta Canada"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0002-3724-598X","authenticated-orcid":false,"given":"Ross T.","family":"Tsuyuki","sequence":"additional","affiliation":[{"name":"Departments of Pharmacology, Medicine, and EPICORE Centre, Faculty of Medicine and Dentistry University of Alberta Edmonton Alberta Canada"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0002-8390-0930","authenticated-orcid":false,"given":"Carl","family":"van Walraven","sequence":"additional","affiliation":[{"name":"Division of General Internal Medicine Ottawa Hospital and the Ottawa Health Research Institute Ottawa Ontario Canada"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0002-3658-2554","authenticated-orcid":false,"given":"Jeffrey A.","family":"Bakal","sequence":"additional","affiliation":[{"name":"Alberta Strategy for Patient Oriented Research Support Unit Edmonton Alberta Canada"},{"name":"Provincial Research Data Services, Alberta Health Services Edmonton Alberta Canada"}],"role":[{"vocabulary":"crossref","role":"author"}]}],"member":"276","reference":[{"key":"e_1_3_2_2_2","doi-asserted-by":"crossref","unstructured":"McAlister FA Hsu Z Dong Y van Walraven C Bakal J. Changes in outpatient care patterns and subsequent outcomes during the COVID\u201019 pandemic: a retrospective cohort analysis from a single payer healthcare system. https:\/\/medrxiv.org\/cgi\/content\/short\/2022.03.07.22272032v1. Accessed October 24 2022.","DOI":"10.1101\/2022.03.07.22272032"},{"key":"e_1_3_2_3_2","doi-asserted-by":"publisher","DOI":"10.1001\/jamanetworkopen.2022.5484"},{"key":"e_1_3_2_4_2","doi-asserted-by":"publisher","DOI":"10.1503\/cmaj.202303"},{"key":"e_1_3_2_5_2","doi-asserted-by":"publisher","DOI":"10.1001\/jamanetworkopen.2021.2618"},{"key":"e_1_3_2_6_2","doi-asserted-by":"publisher","DOI":"10.7326\/M20-3026"},{"key":"e_1_3_2_7_2","doi-asserted-by":"publisher","DOI":"10.1016\/j.cardfail.2020.05.019"},{"key":"e_1_3_2_8_2","doi-asserted-by":"publisher","DOI":"10.1002\/ehf2.13157"},{"key":"e_1_3_2_9_2","doi-asserted-by":"publisher","DOI":"10.1001\/jamanetworkopen.2020.21476"},{"key":"e_1_3_2_10_2","doi-asserted-by":"publisher","DOI":"10.1001\/jamanetworkopen.2021.4157"},{"key":"e_1_3_2_11_2","doi-asserted-by":"publisher","DOI":"10.1016\/j.ahj.2020.10.074"},{"key":"e_1_3_2_12_2","doi-asserted-by":"publisher","DOI":"10.1161\/CIRCHEARTFAILURE.121.008573"},{"key":"e_1_3_2_13_2","doi-asserted-by":"publisher","DOI":"10.1001\/jama.1995.03530040033037"},{"key":"e_1_3_2_14_2","doi-asserted-by":"publisher","DOI":"10.15585\/mmwr.mm6923e1"},{"key":"e_1_3_2_15_2","doi-asserted-by":"publisher","DOI":"10.1001\/jamainternmed.2020.3288"},{"key":"e_1_3_2_16_2","doi-asserted-by":"publisher","DOI":"10.1016\/j.ajem.2021.03.004"},{"key":"e_1_3_2_17_2","doi-asserted-by":"publisher","DOI":"10.1001\/jama.2020.9972"},{"key":"e_1_3_2_18_2","doi-asserted-by":"publisher","DOI":"10.1001\/jamanetworkopen.2022.2933"},{"key":"e_1_3_2_19_2","doi-asserted-by":"publisher","DOI":"10.1001\/jama.2020.24243"},{"key":"e_1_3_2_20_2","doi-asserted-by":"publisher","DOI":"10.2105\/AJPH.2021.306541"},{"key":"e_1_3_2_21_2","doi-asserted-by":"publisher","DOI":"10.7326\/M21-2134"},{"key":"e_1_3_2_22_2","doi-asserted-by":"publisher","DOI":"10.1093\/ije\/dyab207"},{"key":"e_1_3_2_23_2","article-title":"Excess all\u2010cause mortality during the COVID\u201019 epidemic in Canada","author":"Moriarty T","year":"2021","unstructured":"Moriarty T, Boczula AE, Thind EK, Loreto N, McElhaney JE. Excess all\u2010cause mortality during the COVID\u201019 epidemic in Canada. Royal Society of Canada. 2021. https:\/\/rsc\u2010src.ca\/sites\/default\/files\/EM%20PB_EN.pdf. Accessed December 13 2022.","journal-title":"Royal Society of Canada"},{"key":"e_1_3_2_24_2","doi-asserted-by":"publisher","DOI":"10.1093\/eurjpc\/zwab096"},{"key":"e_1_3_2_25_2","doi-asserted-by":"publisher","DOI":"10.1002\/ejhf.2490"},{"key":"e_1_3_2_26_2","doi-asserted-by":"publisher","DOI":"10.1007\/s11606-021-07193-7"},{"key":"e_1_3_2_27_2","doi-asserted-by":"publisher","DOI":"10.1007\/s11606-021-07122-8"},{"key":"e_1_3_2_28_2","doi-asserted-by":"publisher","DOI":"10.1136\/bmjopen-2017-021161"},{"key":"e_1_3_2_29_2","article-title":"Characteristics and healthcare use of patients attending virtual walk\u2010in clinics: a cross\u2010sectional analysis","author":"Lapointe\u2010Shaw L","unstructured":"Lapointe\u2010Shaw L, Salahub C, Bhatia RS, Desveaux L, Glazier RH, Hedden L, Ivers NM, Martin D, Spithoff S, Na Y, et al. Characteristics and healthcare use of patients attending virtual walk\u2010in clinics: a cross\u2010sectional analysis. medRxiv. 2022.02.28.22271640. Accessed Oct 24, 2022. doi: 10.1101\/2022.02.28.22271640","journal-title":"medRxiv"}],"container-title":["Journal of the American Heart Association"],"original-title":[],"language":"en","link":[{"URL":"https:\/\/www.ahajournals.org\/doi\/full\/10.1161\/JAHA.122.027922","content-type":"unspecified","content-version":"vor","intended-application":"similarity-checking"}],"deposited":{"date-parts":[[2024,5,13]],"date-time":"2024-05-13T12:56:10Z","timestamp":1715604970000},"score":1,"resource":{"primary":{"URL":"https:\/\/www.ahajournals.org\/doi\/10.1161\/JAHA.122.027922"}},"subtitle":[],"short-title":[],"issued":{"date-parts":[[2023,2,7]]},"references-count":28,"journal-issue":{"issue":"3","published-print":{"date-parts":[[2023,2,7]]}},"alternative-id":["10.1161\/JAHA.122.027922"],"URL":"https:\/\/doi.org\/10.1161\/jaha.122.027922","relation":{},"ISSN":["2047-9980"],"issn-type":[{"value":"2047-9980","type":"electronic"}],"subject":[],"published":{"date-parts":[[2023,2,7]]},"assertion":[{"value":"2022-09-02","order":0,"name":"received","label":"Received","group":{"name":"publication_history","label":"Publication History"}},{"value":"2022-11-09","order":1,"name":"accepted","label":"Accepted","group":{"name":"publication_history","label":"Publication History"}},{"value":"2023-02-03","order":2,"name":"published","label":"Published","group":{"name":"publication_history","label":"Publication History"}}],"article-number":"e027922"}}