Access to Telehealth and Changes in Diabetes Care Patterns Pre and During the COVID-19 Pandemic - Evidence from a Large Integrated Healthcare System Open Access
Oviedo, Sofia (Spring 2023)
Abstract
Background: Current diabetes management guidelines recommend annual screening of hemoglobin A1c (HbA1c), blood pressure (BP), cholesterol, creatinine, urine albumin-creatinine ratio (UACR), and eye and foot exams. How the shift to telehealth during the COVID-19 pandemic affected adherence to these guidelines, overall and by age, sex and race, is unclear.
Methods: We included all adults (aged ≥18 years) with prevalent diabetes on January 1, 2018, and continuous enrollment at Kaiser Permanente Georgia (KPGA) through December 31, 2021. Prevalent diabetes was defined as a history of at least one of a diagnosis code for diabetes, use of anti-hyperglycemic medication, or at least one laboratory value of HbA1c, fasting plasma glucose or random glucose in the diabetic range. We defined pre (2018-2019) and during COVID-19 (2020-2021) periods. Telehealth utilization was defined as at least one virtual care visit or a scheduled telephone appointment in each period. Adherence to annual guidelines (i.e., at least one measurement per year) was determined from KPGA’s electronic medical record data. Generalized estimating equations, adjusted for baseline age, were used to assess the within-subject change in telehealth utilization and guideline adherence by period.
Results: Among 22,854 adult KPGA members with prevalent diabetes, mean age was 58.9 (±13.0), 44.5% were men, and 57.5% were Black. Telehealth utilization increased from 38.7% in the pre period to 91.5% during COVID-19. The absolute decline in the percentage of those meeting annual guidelines for diabetes processes ranged from -40.7 to -1.9 among non telehealth users and -12.4 to -1.6 among telehealth users, with BP checks being the most disrupted among both telehealth and non telehealth users.
Conclusion: Among members of an integrated healthcare system, adherence to annual diabetes guidelines was disrupted during the pandemic, but was less disrupted among telehealth users. Those who utilized telehealth were more likely to meet guideline recommended screenings, and this was amplified during the COVID-19 period where a large shift to telehealth occurred. Long-term follow-up is needed to assess telehealth’s role in receiving diabetes care in a post COVID-19 era.
Table of Contents
Literature review...............................1
Introduction...................................10
Methods.........................................11
Results...........................................15
Discussion......................................17
References......................................22
Tables............................................30
Figures...........................................40
Supplementary................................42
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