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Ma L, Diaz J, Deconde J, Wong M, Ruo B. Type 2 diabetes-related health measures during the initial COVID-19 surge at an academic internal medicine practice. Prim Care Diabetes 2024; 18:246-247. [PMID: 38278669 DOI: 10.1016/j.pcd.2024.01.007] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/03/2023] [Revised: 12/28/2023] [Accepted: 01/18/2024] [Indexed: 01/28/2024]
Abstract
The COVID-19 pandemic disrupted chronic disease management in the United States and across the world. This study reports minimal effects of the initial COVID-19 surge on body mass index, blood pressure, cholesterol, and blood glucose control in ambulatory general internal medicine patients with Type 2 diabetes at a single academic center.
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Affiliation(s)
- Lawrence Ma
- University of California, San Diego, School of Medicine, Department of Medicine.
| | - Joseph Diaz
- University of California, San Diego, School of Medicine, Department of Medicine
| | - Jennifer Deconde
- University of California, San Diego, School of Medicine, Department of Medicine
| | - Melissa Wong
- University of California, San Diego, School of Medicine, Department of Medicine
| | - Bernice Ruo
- University of California, San Diego, School of Medicine, Department of Medicine
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2
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Cuevas Fernández FJ, Delgado Estévez JL, Hernández Lorenzo M, Segovia Martínez CM, Cabrera León A, Aguirre-Jaime A. [Diabetes control and visits to the family doctor during the COVID-19 pandemic: a multicenter study in primary care]. Aten Primaria 2024; 56:102815. [PMID: 38043174 PMCID: PMC10703598 DOI: 10.1016/j.aprim.2023.102815] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/21/2023] [Revised: 10/25/2023] [Accepted: 11/02/2023] [Indexed: 12/05/2023] Open
Abstract
OBJECTIVES To determine whether in patients with type 2 diabetes (DM2) the changes in their relationship with family doctors during the COVID-19 pandemic, in-person (iPC) and telematic (TC) consultations, were associated with control of their disease. DESIGN Multicentric study of retrospective follow-up. SETTING Seven health centers in Tenerife, Spain. PARTICIPANTS 3543 patients with DM2. MAIN MEASUREMENTS Sex, age, iPC, TC and DM2 control using glycosylated hemoglobin (A1c) during the period 2019-2021. Logistic regression models were fitted with DM2 control as an effect, and with the other measurements as independent variables. RESULTS 50% were women. 38% were less than 65 years old. A1c was measured in 84% of patients in 2019, 68% in 2020, and 77% in 2021. 58.4% had good control in 2019, 46.1% in 2020, and 50.3% in 2021. Median iPC were 7 in 2019, 4 in 2020 and 5 in 2021 (p<0.001). The OR(95%CI) of good control in 2019 were 1.04(1.04-1.05) per year of age and 1.03(1.01-1.04) for each iPC; In 2020 they were 1.04 (1.03-1.05) per year of age, 1.05 (1.04-1.07) for each iPC and 1.04 (1.02-1.07) for each TC; in 2021 they were 1.04 (1.04-1.05) per year of age, 1.05 (1.03-1.06) for each iPC and 1.02 (1.00-1.04) for each TC. CONCLUSIONS The control of patients with DM2 during the period 2019-2021 had a direct relationship with the change in the frequency of consultations at the health center, with differences depending on the type of consultation and the age of the patient.
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Affiliation(s)
- Francisco Javier Cuevas Fernández
- Gerencia de Atención primaria de Tenerife, Santa Cruz de Tenerife, España; Área de Medina Preventiva y Salud Pública, Universidad de La Laguna, Santa Cruz de Tenerife, España
| | - Juan Luis Delgado Estévez
- Gerencia de Atención primaria de Tenerife, Santa Cruz de Tenerife, España; Área de Medina Preventiva y Salud Pública, Universidad de La Laguna, Santa Cruz de Tenerife, España
| | | | - Cristóbal Manuel Segovia Martínez
- Gerencia de Atención primaria de Tenerife, Santa Cruz de Tenerife, España; Área de Medina Preventiva y Salud Pública, Universidad de La Laguna, Santa Cruz de Tenerife, España
| | - Antonio Cabrera León
- Área de Medina Preventiva y Salud Pública, Universidad de La Laguna, Santa Cruz de Tenerife, España; Unidad de Investigación de la Gerencia de Atención Primaria y del Hospital Universitario Nuestra Señora de Candelaria, Santa Cruz de Tenerife, España.
| | - Armando Aguirre-Jaime
- Servicio de Apoyo a la Investigación en Cuidados del Colegio de Enfermer@s de Santa Cruz de Tenerife, España
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Littman AJ, Timmons AK, Jones KT, Shirley S, Robbins J, Moy E. Assessing equity in the uptake of remote foot temperature monitoring in a large integrated US healthcare system. PLoS One 2024; 19:e0301260. [PMID: 38557772 PMCID: PMC10984545 DOI: 10.1371/journal.pone.0301260] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/18/2023] [Accepted: 03/13/2024] [Indexed: 04/04/2024] Open
Abstract
OBJECTIVE We assessed equity in the uptake of remote foot temperature monitoring (RTM) for amputation prevention throughout a large, integrated US healthcare system between 2019 and 2021, including comparisons across facilities and between patients enrolled and eligible patients not enrolled in RTM focusing on the Reach and Adoption dimensions of the Reach, Effectiveness, Adoption, Implementation, and Maintenance (RE-AIM) framework. MATERIAL AND METHODS To assess whether there was equitable use of RTM across facilities, we examined distributions of patient demographic, geographic, and facility characteristics across facility RTM use categories (e.g., no RTM use, and low, moderate, and high RTM use) among all eligible patients (n = 46,294). Second, to understand whether, among facilities using RTM, there was equitable enrollment of patients in RTM, we compared characteristics of patients enrolled in RTM (n = 1066) relative to a group of eligible patients not enrolled in RTM (n = 27,166) using logistic regression and including all covariates. RESULTS RTM use increased substantially from an average of 11 patients per month to over 40 patients per month between 2019 and 2021. High-use RTM facilities had higher complexity and a lower ratio of patients per podiatrist but did not have consistent evidence of better footcare process measures. Among facilities offering RTM, enrollment varied by age, was inversely associated with Black race (vs. white), low income, living far from specialty care, and being in the highest quartiles of telehealth use prior to enrollment. Enrollment was positively associated with having osteomyelitis, Charcot foot, a partial foot amputation, BMI≥30 kg/m2, and high outpatient utilization. CONCLUSIONS RTM growth was concentrated in a small number of higher-resourced facilities, with evidence of lower enrollment among those who were Black and lived farther from specialty care. Future studies are needed to identify and address barriers to uptake of new interventions like RTM to prevent exacerbating existing ulceration and amputation disparities.
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Affiliation(s)
- Alyson J. Littman
- Seattle Epidemiologic Research and Information Center, Department of Veterans Affairs Puget Sound Health Care System, Seattle, WA, United States of America
- Seattle-Denver Center of Innovation for Veteran-Centered and Value-Driven Care, Health Services, Seattle, WA, United States of America
- Department of Epidemiology, University of Washington School of Public Health, Seattle, WA, United States of America
| | - Andrew K. Timmons
- Seattle Epidemiologic Research and Information Center, Department of Veterans Affairs Puget Sound Health Care System, Seattle, WA, United States of America
| | - Kenneth T. Jones
- VA Office of Health Equity, Washington, DC, United States of America
| | - Suzanne Shirley
- VHA Innovation Ecosystem, Washington, DC, United States of America
| | - Jeffrey Robbins
- Specialty Care Services, Podiatry Program Office, VA Central Office, Washington, DC, United States of America
| | - Ernest Moy
- VA Office of Health Equity, Washington, DC, United States of America
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Hartmann-Boyce J, Highton P, Rees K, Onakpoya I, Suklan J, Curtis F, O'Mahoney L, Morris E, Kudlek L, Morgan J, Lynch R, Marpadga S, Seidu S, Khunti K. The impact of the COVID-19 pandemic and associated disruptions in health-care provision on clinical outcomes in people with diabetes: a systematic review. Lancet Diabetes Endocrinol 2024; 12:132-148. [PMID: 38272607 DOI: 10.1016/s2213-8587(23)00351-0] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/12/2023] [Revised: 11/10/2023] [Accepted: 11/13/2023] [Indexed: 01/27/2024]
Abstract
The COVID-19 pandemic triggered disruptions to health care and lifestyles that could conceivably impact diabetes management. We set out to identify the impact of disruptions caused by COVID-19 on clinical outcomes in people with diabetes. We performed a systematic review of the available literature in the MEDLINE and OVID databases from Jan 1, 2020, to June 7, 2023, and included 138 studies (n>1 000 000 people). All but five studies were judged to be at some risk of bias. All studies compared prepandemic with pandemic periods. All-cause mortality (six studies) and diabetes-related mortality (13 studies) showed consistent increases, and most studies indicated increases in sight loss (six studies). In adult and mixed samples, data generally suggested no difference in diabetic ketoacidosis frequency or severity, whereas in children and adolescents most studies showed increases with some due to new-onset diabetes (69 studies). Data suggested decreases in hospital admissions in adults but increases in diabetes-related admissions to paediatric intensive care units (35 studies). Data were equivocal on diabetic foot ulcer presentations (nine studies), emergency department admissions (nine studies), and overall amputation rates (20 studies). No studies investigated renal failure. Where reported, the impact was most pronounced for females, younger people, and racial and ethnic minority groups. Further studies are needed to investigate the longer-term impact of the pandemic and the on potential differential impacts, which risk further exacerbating existing inequalities within people with diabetes.
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Affiliation(s)
- Jamie Hartmann-Boyce
- Department of Health Promotion and Policy, University of Massachusetts Amherst, Amherst, MA, USA; Nuffield Department of Primary Care Health Sciences, University of Oxford, Oxford, UK.
| | | | | | - Igho Onakpoya
- Department for Continuing Education, University of Oxford, Oxford, UK
| | - Jana Suklan
- National Institute for Health and Care Research Newcastle In Vitro Diagnostics Co-operative, Newcastle University, Newcastle, UK
| | - Ffion Curtis
- Liverpool Reviews and Implementation Group, University of Liverpool, Liverpool, UK
| | | | - Elizabeth Morris
- Nuffield Department of Primary Care Health Sciences, University of Oxford, Oxford, UK
| | - Laura Kudlek
- Medical Research Council Epidemiology Unit, University of Cambridge, Cambridge, UK
| | - Jessica Morgan
- Medical Sciences Division, University of Oxford, Oxford, UK
| | - Rosie Lynch
- Medical Sciences Division, University of Oxford, Oxford, UK
| | | | - Samuel Seidu
- Diabetes Research Centre, University of Leicester, UK
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Connolly SL, Sherman SE, Dardashti N, Duran E, Bosworth HB, Charness ME, Newton TJ, Reddy A, Wong ES, Zullig LL, Gutierrez J. Defining and Improving Outcomes Measurement for Virtual Care: Report from the VHA State-of-the-Art Conference on Virtual Care. J Gen Intern Med 2024; 39:29-35. [PMID: 38252238 PMCID: PMC10937867 DOI: 10.1007/s11606-023-08464-1] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/01/2023] [Accepted: 10/06/2023] [Indexed: 01/23/2024]
Abstract
Virtual care, including synchronous and asynchronous telehealth, remote patient monitoring, and the collection and interpretation of patient-generated health data (PGHD), has the potential to transform healthcare delivery and increase access to care. The Veterans Health Administration (VHA) Office of Health Services Research and Development (HSR&D) convened a State-of-the-Art (SOTA) Conference on Virtual Care to identify future virtual care research priorities. Participants were divided into three workgroups focused on virtual care access, engagement, and outcomes. In this article, we report the findings of the Outcomes Workgroup. The group identified virtual care outcome areas with sufficient evidence, areas in need of additional research, and areas that are particularly well-suited to be studied within VHA. Following a rigorous process of literature review and consensus, the group focused on four questions: (1) What outcomes of virtual care should we be measuring and how should we measure them?; (2) how do we choose the "right" care modality for the "right" patient?; (3) what are potential consequences of virtual care on patient safety?; and (4) how can PGHD be used to benefit provider decision-making and patient self-management?. The current article outlines key conclusions that emerged following discussion of these questions, including recommendations for future research.
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Affiliation(s)
- Samantha L Connolly
- Center for Healthcare Organization and Implementation Research (CHOIR), VA Boston Healthcare System, Boston, MA, USA.
- Department of Psychiatry, Harvard Medical School, Boston, MA, USA.
| | - Scott E Sherman
- Virtual Care Consortium of Research (VC CORE), VA New York Harbor Healthcare System, New York, NY, USA
- Department of Population Health, NYU Grossman School of Medicine, New York, NY, USA
| | - Navid Dardashti
- Virtual Care Consortium of Research (VC CORE), VA New York Harbor Healthcare System, New York, NY, USA
| | - Elizabeth Duran
- Virtual Care Consortium of Research (VC CORE), VA New York Harbor Healthcare System, New York, NY, USA
| | - Hayden B Bosworth
- Center of Innovation to Accelerate Discovery and Practice Transformation (ADAPT) Durham Veterans Affairs Medical Center, Durham, NC, USA
- Department of Population Health Sciences, Duke University Medical Center, Durham, NC, USA
| | - Michael E Charness
- Chief of Staff of the VA Boston Healthcare System, Boston, MA, USA
- Department of Neurology, Harvard Medical School, Boston, MA, USA
- Department of Neurology, Boston University Chobanian & Avedisian School of Medicine, Boston, MA, USA
| | - Terry J Newton
- Director of Clinical Analytics, VA Office of Connected Care, Washington, DC, USA
| | - Ashok Reddy
- General Medicine Service, VA Puget Sound Health Care System, Seattle, WA, USA
- Department of Medicine, University of Washington School of Medicine, Seattle, WA, USA
| | - Edwin S Wong
- Center of Innovation for Veteran-Centered and Value-Driven Care, VA Puget Sound Health Care System, Seattle, WA, USA
- Department of Health Systems and Population Health, University of Washington, Seattle, USA
| | - Leah L Zullig
- Center of Innovation to Accelerate Discovery and Practice Transformation (ADAPT) Durham Veterans Affairs Medical Center, Durham, NC, USA
- Department of Population Health Sciences, Duke University Medical Center, Durham, NC, USA
| | - Jeydith Gutierrez
- Center for Access and Delivery Research, Iowa City VA Healthcare System, Iowa City, IA, USA
- Department of Internal Medicine, University of Iowa, Iowa City, IA, USA
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Zupa MF, Vimalananda VG, Rothenberger SD, Lin JY, Ng JM, McCoy RG, Rosland AM. Patterns of Telemedicine Use and Glycemic Outcomes of Endocrinology Care for Patients With Type 2 Diabetes. JAMA Netw Open 2023; 6:e2346305. [PMID: 38055278 PMCID: PMC10701613 DOI: 10.1001/jamanetworkopen.2023.46305] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/25/2023] [Accepted: 10/23/2023] [Indexed: 12/07/2023] Open
Abstract
Importance Telemedicine can increase access to endocrinology care for people with type 2 diabetes (T2D), but patterns of use and outcomes of telemedicine specialty care for adults with T2D beyond initial uptake in 2020 are not known. Objective To evaluate patterns of telemedicine use and their association with glycemic control among adults with varying clinical complexity receiving endocrinology care for T2D. Design, Setting, and Participants Retrospective cohort study in a single large integrated US health system. Participants were adults who had a telemedicine endocrinology visit for T2D from May to October 2020. Data were analyzed from June 2022 to October 2023. Exposure Patients were followed up through May 2022 and assigned to telemedicine-only, in-person, or mixed care (both telemedicine and in-person) cohorts according to visit modality. Main Outcomes and Measures Multivariable regression models were used to estimate hemoglobin A1c (HbA1c) change at 12 months within each cohort and the association of factors indicating clinical complexity (insulin regimen and cardiovascular and psychological comorbidities) with HbA1c change across cohorts. Subgroup analysis was performed for patients with baseline HbA1c of 8% or higher. Results Of 11 498 potentially eligible patients, 3778 were included in the final cohort (81 Asian participants [2%], 300 Black participants [8%], and 3332 White participants [88%]); 1182 used telemedicine only (mean [SD] age 57.4 [12.9] years; 743 female participants [63%]), 1049 used in-person care (mean [SD] age 63.0 [12.2] years; 577 female participants [55%]), and 1547 used mixed care (mean [SD] age 60.7 [12.5] years; 881 female participants [57%]). Among telemedicine-only patients, there was no significant change in adjusted HbA1c at 12 months (-0.06%; 95% CI, -0.26% to 0.14%; P = .55) while in-person and mixed cohorts had improvements of 0.37% (95% CI, 0.15% to 0.59%; P < .001) and 0.22% (95% CI, 0.07% to 0.38%; P = .004), respectively. Patients with a baseline HbA1c of 8% or higher had a similar pattern of glycemic outcomes. For patients prescribed multiple daily injections vs no insulin, the 12-month estimated change in HbA1c was 0.25% higher (95% CI, 0.02% to 0.47%; P = .03) for telemedicine vs in-person care. Comorbidities were not associated with HbA1c change in any cohort. Conclusions and Relevance In this cohort study of adults with T2D receiving endocrinology care, patients using telemedicine alone had inferior glycemic outcomes compared with patients who used in-person or mixed care. Additional strategies may be needed to support adults with T2D who rely on telemedicine alone to access endocrinology care, especially for those with complex treatment or elevated HbA1c.
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Affiliation(s)
- Margaret F. Zupa
- Division of Endocrinology and Metabolism, University of Pittsburgh School of Medicine, Pennsylvania
| | - Varsha G. Vimalananda
- Center for Health Outcomes Research, Veterans Affairs Bedford Healthcare System, Bedford, Massachusetts
- Department of Medicine, Boston University School of Medicine, Massachusetts
| | - Scott D. Rothenberger
- Division of General Internal Medicine, University of Pittsburgh School of Medicine, Pennsylvania
| | - Jonathan Y. Lin
- Division of General Internal Medicine, University of Pittsburgh School of Medicine, Pennsylvania
| | - Jason M. Ng
- Division of Endocrinology and Metabolism, University of Pittsburgh School of Medicine, Pennsylvania
| | - Rozalina G. McCoy
- Division of Endocrinology, Diabetes, and Nutrition, University of Maryland School of Medicine, Baltimore
- University of Maryland Institute for Health Computing, Bethesda
| | - Ann-Marie Rosland
- Division of General Internal Medicine, University of Pittsburgh School of Medicine, Pennsylvania
- Center for Health Equity Research and Promotion, Veterans Affairs Pittsburgh Healthcare System, Pennsylvania
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Alanzi TM, Alzahrani W, Almoraikhi M, Algannas A, Alghamdi M, Alzahrani L, Abutaleb R, Ba Dughaish R, Alotibi N, Alkhalifah S, Alshehri M, Alzahrani H, Almahdi R, Alanzi N, Farhah N. Adoption of Wearable Insulin Biosensors for Diabetes Management: A Cross-Sectional Study. Cureus 2023; 15:e50782. [PMID: 38239544 PMCID: PMC10795719 DOI: 10.7759/cureus.50782] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 12/17/2023] [Indexed: 01/22/2024] Open
Abstract
BACKGROUND Wearable insulin biosensors represent a novel approach that combines the benefits of real-time glucose monitoring and automated insulin delivery, potentially revolutionizing how individuals with diabetes manage their condition. STUDY PURPOSE To analyze the behavioral intentions of wearable insulin biosensors among diabetes patients, the factors that drive or hinder their usage, and the implications for diabetes management and healthcare outcomes. METHODS A cross-sectional survey design was adopted in this study. The validated questionnaire included 10 factors (Performance expectancy, effort expectancy, social influence, facilitating conditions, behavioral intention, trust, perceived privacy risk, and personal innovativeness) affecting the acceptance of wearable insulin sensors. A total of 248 diabetic patients who had used wearable sensors participated in the study. RESULTS Performance expectancy was rated the highest (Mean = 3.84 out of 5), followed by effort expectancy (Mean = 3.78 out of 5), and trust (Mean = 3.53 out of 5). Statistically significant differences (p < 0.05) were observed with respect to socio-demographic variables including age and gender on various influencing factors and adoption intentions. PE, EE, and trust were positively associated with adoption intentions. CONCLUSION While wearable insulin sensors are positively perceived with respect to diabetes management, issues like privacy and security may affect their adoption.
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Affiliation(s)
- Turki M Alanzi
- Department of Health Information Management and Technology, College of Public Health, Imam Abdulrahman Bin Faisal University, Dammam, SAU
| | - Wala Alzahrani
- Department of Clinical Nutrition, College of Applied Medical Sciences, King Abdulaziz University, Jeddah, SAU
| | | | | | - Mohammed Alghamdi
- Department of Pharmaceutical Services, Dhahran Long Term Care Hospital, Dhahran, SAU
| | | | | | | | - Nada Alotibi
- College of Pharmacy, Shaqra University, Shaqra, SAU
| | - Shayma Alkhalifah
- College of Medicine, Imam Abdulrahman Bin Faisal University, Dammam, SAU
| | - Mona Alshehri
- College of Medicine, Princess Nourah Bint Abdul Rahman University, Riyadh, SAU
| | | | - Reham Almahdi
- College of Medicine, Al Baha University, Al Baha, SAU
| | - Nouf Alanzi
- Department of Clinical Laboratories Sciences, College of Applied Medical Sciences, Jouf University, Jouf, SAU
| | - Nesren Farhah
- Department of Health Informatics, College of Health Sciences, Saudi Electronic University, Riyadh, SAU
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Bak JCG, Serné EH, Groenwold RHH, de Valk HW, Kramer MHH, Nieuwdorp M, Verheugt CL. Effects of COVID-19 on diabetes care among dutch diabetes outpatients. Diabetol Metab Syndr 2023; 15:193. [PMID: 37817214 PMCID: PMC10563332 DOI: 10.1186/s13098-023-01169-9] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/29/2023] [Accepted: 09/21/2023] [Indexed: 10/12/2023] Open
Abstract
AIMS The COVID-19 pandemic impacted diabetes care by reducing diabetes outpatient visits and diabetes-related screening due to allocation of healthcare resources. Yet the impact of COVID-19 on diabetes outpatients has not been extensively evaluated. This study aimed to assess the effect of the COVID-19 pandemic on diagnostics and intermediate outcomes of outpatient diabetes care pre- and during COVID. METHODS This observational cohort study included 8,442 diabetes patients in the Dutch Pediatric and Adult Registry of Diabetes (DPARD) visiting diabetes outpatient clinics in 2019 and 2021. A mixed-effects regression analysis was used to examine differences in target achievement of HbA1c, BMI, blood pressure, LDL-cholesterol, eGFR, and the difference in mean HbA1c between 2019 and 2020 among n = 1,426 outpatients who visited in both years. Analyses were adjusted for age, sex, and BMI. RESULTS A 22.7% (21.6-23.8%, p < 0.001) decline in outpatient volume was observed during the pandemic (2020). BMI, lipid spectrum, kidney function, and HbA1c were assessed less frequently in 2020 than in 2019. In 2020, compared to 2019, the median HbA1c level increased by 2.2% (1.0 mmol/mol, p = 0.035) and the percentages of patients with known HbA1C meeting targets below 10, 8, 7% (86, 64, and 53 mmol/mol) decreased by 0.5%, 1.7% and 1.4%, respectively. Target blood pressure ≤ 130/80 mmHg was achieved more often in 2020 (15.0% versus 18.3%, p = 0.018), while HbA1c ≤ 86 mmol/mol was achieved less (89.3% versus 87.1%, p = 0.001), among diabetes outpatients seen in both 2019 and 2020. In patients visiting both years, HbA1c was 2.3% (1.9 mmol/l, 95% CI 1.2-2.5, p < 0.001) lower during the pandemic than in the prepandemic (2019). CONCLUSIONS The COVID pandemic was associated with a marked reduction in patient volume in diabetes outpatient care among five hospitals. Among patients who received outpatient care both before and during the pandemic period, HbA1c control and blood pressure control enhanced during the pandemic. Re-evaluation of current diabetes outpatient care organization is warranted to ensure optimal diabetes care in future times.
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Affiliation(s)
- Jessica C G Bak
- Department of Vascular Medicine, Amsterdam University Medical Centers, location AMC Meibergdreef 9, Amsterdam, 1105 AZ, The Netherlands
- Dutch Institute for Clinical Auditing, Leiden, the Netherlands
| | - Erik H Serné
- Department of Vascular Medicine, Amsterdam University Medical Centers, location AMC Meibergdreef 9, Amsterdam, 1105 AZ, The Netherlands
| | | | | | - Mark H H Kramer
- Department of Vascular Medicine, Amsterdam University Medical Centers, location AMC Meibergdreef 9, Amsterdam, 1105 AZ, The Netherlands
| | - Max Nieuwdorp
- Department of Vascular Medicine, Amsterdam University Medical Centers, location AMC Meibergdreef 9, Amsterdam, 1105 AZ, The Netherlands
| | - Carianne L Verheugt
- Department of Vascular Medicine, Amsterdam University Medical Centers, location AMC Meibergdreef 9, Amsterdam, 1105 AZ, The Netherlands.
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Barzegari J, Raeissi P, Hashemi SM, Aryan Khesal A, Reisi N. Delivering Primary Health Care (PHC) Services for Controlling NCDs During the COVID-19 Pandemic: A Scoping Review. JOURNAL OF PREVENTION (2022) 2023; 44:579-601. [PMID: 37495870 DOI: 10.1007/s10935-023-00733-3] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Accepted: 04/05/2023] [Indexed: 07/28/2023]
Abstract
Non-communicable diseases (NCDs) are the leading cause of death worldwide. NCDs also increase mortality from COVID-19 and primary health care (PHC) services are an important component in the prevention and control of long-term NCDs. The main goal of the present study was to review primary healthcare services for the NCDs patients via primary healthcare network during COVID-19 pandemic. In this scoping review, Search engines including PubMed, Scopus, and Science-direct up to 1st February 2022 were searched to identify studies regarding primary care services for NCDs patients via primary health care during COVID-19 pandemic. A total of 42 studies met the inclusion criteria and were included in our analysis. 24 studies were about the status and changes of primary health services for NCDs patients in PHC settings, while 18 studies focused on adaptive strategies used during COVID-19 in different countries including United States, Canada, United Kingdom, Portugal, Georgia, South Africa, Thailand, Mexico, India, Kenya, Guatemala and Saudi Arabia. These strategies included remote monitoring, follow up, consultation, empowerment and educational services as well as home visiting Disruption of NCDs services in PHC during the COVID-19 pandemic was observed in different countries, which highlights the urgency of attention of researchers and policy-makers to development of appropriate and adaptive policies to improve PHC service coverage and its quality during the pandemics.
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Affiliation(s)
- Javad Barzegari
- Department of Health Services Management, School of Health Services Management and Medical Information Science, Iran University of Medical Sciences, No. 6, Rashid Yasemi St. Vali -e Asr Ave, P.O Box: 1996713883, Tehran, Iran
| | - Pouran Raeissi
- Department of Health Services Management, School of Health Services Management and Medical Information Science, Iran University of Medical Sciences, No. 6, Rashid Yasemi St. Vali -e Asr Ave, P.O Box: 1996713883, Tehran, Iran.
| | - Seyed- Masoud Hashemi
- Department of Anesthesiology, Faculty of Medicine, Shahid Beheshti University of Medical Sciences, Tehran, Iran
| | - Aidin Aryan Khesal
- Department of Health Services Management, School of Health Services Management and Medical Information Science, Iran University of Medical Sciences, No. 6, Rashid Yasemi St. Vali -e Asr Ave, P.O Box: 1996713883, Tehran, Iran
| | - Nahid Reisi
- Department of Pediatric Hematology and Oncology, Faculty of Medicine, Child Growth and Development Research Center and Isfahan Immunodeficiency Research Center, Isfahan University of Medical Sciences, Isfahan, Iran
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10
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Frontera ED, Cavagahan MK, Carter A, Saeed ZI. Health Care Disparities in Outpatient Diabetes Management During the Coronavirus Disease 2019 Pandemic: Where Do We Stand Now? Endocr Pract 2023; 29:529-537. [PMID: 37121402 PMCID: PMC10141790 DOI: 10.1016/j.eprac.2023.04.009] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/15/2023] [Revised: 04/03/2023] [Accepted: 04/23/2023] [Indexed: 05/02/2023]
Abstract
OBJECTIVE We examined diabetes outpatient management during the first 2 years of the Coronavirus Disease 2019 pandemic in an endocrinology practice with a focus on health care disparities in outcomes. METHODS We conducted a retrospective cohort study examining adults with diabetes during 3 time periods: T1 (March 2019-February 2020), T2 (March 2020-February 2021), and T3 (March 2021-February 2022). Clinical outcomes included body mass index (BMI), systolic blood pressure (SBP), Hemoglobin A1c (HgbA1c), low-density lipoprotein cholesterol (LDL), and urine albumin:creatinine ratio. Appointment types (virtual vs in-person) were also collected. RESULTS Frequencies of HgbA1c, BMI, and SBP measurements reduced by 36.0%, 46.3%, and 48.5% in T2, respectively, and remaining 8.7% (HgbA1c), 13.4% (BMI), and 15.2% (SBP) lower at the end of the study period (P < .001) compared to prepandemic levels. However, the average HgbA1c and LDL slightly improved. Clinic appointments per patient increased during the pandemic, fueled by telehealth utilization. Women had fewer in-person visits during T2, those older than 65 had better HgbA1c, and the most socioeconomically deprived group had the worst HgbA1c during every time period. In addition, black patients had worse HgbA1c, LDL, and SBP values throughout the study, which did not worsen over the pandemic. CONCLUSION While the frequency of health measurements had not fully recovered 2 years into the pandemic, this did not translate to worse diabetes management or a widening of pre-existing disparities. Our study emphasizes the role of equitable health care in minimizing inequalities in diabetes, particularly during times of crisis.
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Affiliation(s)
- Eric D Frontera
- Department of Medicine, Indiana University School of Medicine, Indianapolis, Indiana
| | - Melissa K Cavagahan
- Division of Endocrinology, Diabetes and Metabolism, Indiana University School of Medicine, Indianapolis, Indiana
| | - Allie Carter
- Department of Biostatistics and Health Data Science, Indiana University School of Medicine, Indianapolis, Indiana
| | - Zeb I Saeed
- Division of Endocrinology, Diabetes and Metabolism, Indiana University School of Medicine, Indianapolis, Indiana.
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11
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Akinosoglou K, Schinas G, Bletsa E, Bristianou M, Lanaras L, Michailides C, Katsikas T, Barkas F, Liberopoulos E, Kotsis V, Tentolouris K, Grigoropoulou P, Frangou A, Basoulis D, Alexiou Z, Daganou M, Bostantzoglou C, Dimakopoulou V, Koutsoukou A, Pefanis A, Baraboutis IG, Agelonidou E, Tentolouris N. COVID-19 Outcomes and Diabetes Mellitus: A Comprehensive Multicenter Prospective Cohort Study. Microorganisms 2023; 11:1416. [PMID: 37374918 DOI: 10.3390/microorganisms11061416] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/30/2023] [Revised: 05/17/2023] [Accepted: 05/24/2023] [Indexed: 06/29/2023] Open
Abstract
The link between type 2 diabetes (T2D) and the severe outcomes of COVID-19 has raised concerns about the optimal management of patients with T2D. This study aimed to investigate the clinical characteristics and outcomes of T2D patients hospitalized with COVID-19 and explore the potential associations between chronic T2D treatments and adverse outcomes. This was a multicenter prospective cohort study of T2D patients hospitalized with COVID-19 in Greece during the third wave of the pandemic (February-June 2021). Among the 354 T2D patients included in this study, 63 (18.6%) died during hospitalization, and 16.4% required ICU admission. The use of DPP4 inhibitors for the chronic management of T2D was associated with an increased risk of in-hospital death (adjusted odds ratio (adj. OR) 2.639, 95% confidence interval (CI) 1.148-6.068, p = 0.022), ICU admission (adj. OR = 2.524, 95% CI: 1.217-5.232, p = 0.013), and progression to ARDS (adj. OR = 2.507, 95% CI: 1.278-4.916, p = 0.007). Furthermore, the use of DPP4 inhibitors was significantly associated with an increased risk of thromboembolic events (adjusted OR of 2.249, 95% CI: 1.073-4.713, p = 0.032) during hospitalization. These findings highlight the importance of considering the potential impact of chronic T2D treatment regiments on COVID-19 and the need for further studies to elucidate the underlying mechanisms.
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Affiliation(s)
- Karolina Akinosoglou
- Department of Internal Medicine, Faculty of Medicine, University of Patras, University Hospital of Patras, 265 04 Patras, Greece
| | - Georgios Schinas
- Department of Internal Medicine, Faculty of Medicine, University of Patras, University Hospital of Patras, 265 04 Patras, Greece
| | - Evanthia Bletsa
- Department of Internal Medicine, General Hospital of Lamia, 351 00 Lamia, Greece
| | - Magdaline Bristianou
- Department of Internal Medicine, General Hospital of Lamia, 351 00 Lamia, Greece
| | - Leonidas Lanaras
- Department of Internal Medicine, General Hospital of Lamia, 351 00 Lamia, Greece
| | - Charalambos Michailides
- 1st Department of Internal Medicine, General Hospital of Athens "G. Gennimatas", 115 27 Athens, Greece
| | - Theodoros Katsikas
- 1st Department of Internal Medicine, General Hospital of Athens "G. Gennimatas", 115 27 Athens, Greece
| | - Fotios Barkas
- 2nd Department of Internal Medicine, Faculty of Medicine, School of Health Sciences, University of Ioannina, 451 10 Ioannina, Greece
| | - Evangelos Liberopoulos
- 2nd Department of Internal Medicine, Faculty of Medicine, School of Health Sciences, University of Ioannina, 451 10 Ioannina, Greece
| | - Vasileios Kotsis
- 3rd Department of Internal Medicine, Medical School, Aristotle University of Thessaloniki, General Hospital of Thessaloniki "Papageorgiou", 564 29 Thessaloniki, Greece
| | | | - Pinelopi Grigoropoulou
- Department of Internal Medicine, General Hospital of Athens "Elpis", 115 22 Athens, Greece
| | - Archontoula Frangou
- Department of Internal Medicine, General Hospital of Athens "Elpis", 115 22 Athens, Greece
| | - Dimitrios Basoulis
- 1st Department of Internal Medicine, Medical School, National and Kapodistrian University of Athens, Laiko General Hospital, 11527 Athens, Greece
| | - Zoi Alexiou
- General Hospital of Eleusis "Thriasio", 196 00 Athens, Greece
| | - Mary Daganou
- Intensive Care Unit, General Hospital for Thoracic Diseases "Sotiria", 115 27 Athens, Greece
| | | | - Vasiliki Dimakopoulou
- Department of Internal Medicine, Faculty of Medicine, University of Patras, University Hospital of Patras, 265 04 Patras, Greece
| | - Antonia Koutsoukou
- 1st University Pulmonology Clinic and ICU, Medical School, National and Kapodistrian University of Athens, General Hospital for Thoracic Diseases "Sotiria", 115 27 Athens, Greece
| | - Angelos Pefanis
- Department of Medicine and 1st Department of Infectious Diseases, General Hospital for Thoracic Diseases "Sotiria", 115 27 Athens, Greece
| | - Ioannis G Baraboutis
- Department of Internal Medicine, "Pammakaristos" Hospital, 111 44 Athens, Greece
| | - Eleni Agelonidou
- Department of Internal Medicine, "Pammakaristos" Hospital, 111 44 Athens, Greece
| | - Nikolaos Tentolouris
- 1st Department of Internal Medicine, Medical School, National and Kapodistrian University of Athens, Laiko General Hospital, 11527 Athens, Greece
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12
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Zupa MF, Alexopoulos AS, Esteve L, Rosland AM. Specialist Perspectives on Delivering High-Quality Telemedicine for Diabetes: A Mixed Methods Survey Study. J Endocr Soc 2023; 7:bvad039. [PMID: 37035500 PMCID: PMC10074391 DOI: 10.1210/jendso/bvad039] [Citation(s) in RCA: 2] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/06/2023] [Indexed: 03/22/2023] Open
Abstract
Background Recent recommendations guiding appropriate use of telemedicine for endocrinology care have largely relied on expert opinion due to limited evidence on factors that increase quality of telemedicine care. In this study, we assessed the perspectives of front-line specialists on factors and strategies perceived to increase quality of diabetes care delivered via telemedicine after more than 2 years of widespread use. Methods Adult diabetes specialists in 2 academic health systems who recently used video-based telemedicine to provide diabetes care were invited to participate in an online survey study between March and April 2022. Likert-style questions, followed by related open-ended questions, assessed perspectives on availability of key resources, factors affecting quality, and anticipated benefits from telemedicine for diabetes. Results Response rate was 52% (56/111). More than half (54%) of participants reported better overall quality of diabetes care with face-to-face care vs telemedicine. Participants reported clinical data supporting high-quality care, such as home blood glucose readings and vital signs, were often not available with telemedicine. Patient factors, including comorbidities and communication barriers, reduced anticipated benefit from telemedicine, while geographic and mobility barriers increased expected benefit. Providers described multiple health care setting resources that could promote high-quality telemedicine diabetes care, including greater support for sharing patient-generated health data and coordinating multidisciplinary care. Conclusions After 2 years of sustained use, diabetes specialists identified telemedicine as an important way to enhance access to care. However, specialists identified additional supports needed to increase appropriate use and delivery of high-quality telemedicine care for patients with complex clinical needs.
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Affiliation(s)
- Margaret F Zupa
- University of Pittsburgh School of Medicine, Division of Endocrinology and Metabolism, Pittsburgh, PA, USA
| | - Anastasia-Stefania Alexopoulos
- Duke University School of Medicine, Division of Endocrinology, Metabolism, and Nutrition, Durham, NC, USA
- Center of Innovation to Accelerate Discovery and Practice Transformation, Durham Veterans Affairs Health Care System, Durham, NC, USA
| | - Lucy Esteve
- Duke University School of Medicine, Division of Endocrinology, Metabolism, and Nutrition, Durham, NC, USA
| | - Ann-Marie Rosland
- University of Pittsburgh School of Medicine, Division of General Internal Medicine, Pittsburgh, PA, USA
- VA Pittsburgh Center for Health Equity and Research Promotion, Pittsburgh, PA, USA
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13
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Faruqi J, Balasubramanyam A. COVID-19 and diabetes mellitus: a review of the incidence, pathophysiology and management of diabetes during the pandemic. Expert Rev Endocrinol Metab 2023; 18:167-179. [PMID: 36797835 DOI: 10.1080/17446651.2023.2176300] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/19/2022] [Accepted: 01/31/2023] [Indexed: 02/05/2023]
Abstract
INTRODUCTION The COVID-19 pandemic has changed the landscape of modern medicine on a global scale. An emerging concern is the recognition of a bidirectional relationship between COVID-19 and diabetes. Diabetes is a risk factor for severe COVID-19 illness. Intriguingly, recent epidemiological and in vitro studies suggest that infection with SARS-CoV-2, the causative viral agent of COVID-19, is associated with new-onset diabetes and worsening diabetes control. These factors have affected the management of diabetes. AREAS COVERED This review provides an overview of our current understanding of the incidence and prevalence of diabetes in relation to the COVID-19 pandemic, highlights studies evaluating SARS-CoV-2's beta cell tropism and its effects on insulin secretion and sensitivity and evaluates the impact of the pandemic on diabetes management and metabolic control. EXPERT OPINION Epidemiological studies have noted an increase in the incidence of new-onset diabetes associated with COVID-19 in patients with phenotypes of type 1 diabetes, type 2 diabetes and Ketosis-Prone Diabetes. Prospective studies are needed to fully elucidate the association between COVID-19 and diabetes and to characterize persons at risk of developing diabetes after SARS-CoV-2 infection, identify those who should be screened for diabetes, and determine the natural histories of different forms of diabetes associated with COVID-19.
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Affiliation(s)
- Jordana Faruqi
- Division of Diabetes, Endocrinology and Metabolism, Baylor College of Medicine, Houston, TX, USA
| | - Ashok Balasubramanyam
- Division of Diabetes, Endocrinology and Metabolism, Baylor College of Medicine, Houston, TX, USA
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14
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Bai L, Lu K, Dong Y, Wang X, Gong Y, Xia Y, Wang X, Chen L, Yan S, Tang Z, Li C. Predicting monthly hospital outpatient visits based on meteorological environmental factors using the ARIMA model. Sci Rep 2023; 13:2691. [PMID: 36792764 PMCID: PMC9930044 DOI: 10.1038/s41598-023-29897-y] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/24/2022] [Accepted: 02/13/2023] [Indexed: 02/17/2023] Open
Abstract
Accurate forecasting of hospital outpatient visits is beneficial to the rational planning and allocation of medical resources to meet medical needs. Several studies have suggested that outpatient visits are related to meteorological environmental factors. We aimed to use the autoregressive integrated moving average (ARIMA) model to analyze the relationship between meteorological environmental factors and outpatient visits. Also, outpatient visits can be forecast for the future period. Monthly outpatient visits and meteorological environmental factors were collected from January 2015 to July 2021. An ARIMAX model was constructed by incorporating meteorological environmental factors as covariates to the ARIMA model, by evaluating the stationary [Formula: see text], coefficient of determination [Formula: see text], mean absolute percentage error (MAPE), and normalized Bayesian information criterion (BIC). The ARIMA [Formula: see text] model with the covariates of [Formula: see text], [Formula: see text], and [Formula: see text] was the optimal model. Monthly outpatient visits in 2019 can be predicted using average data from past years. The relative error between the predicted and actual values for 2019 was 2.77%. Our study suggests that [Formula: see text], [Formula: see text], and [Formula: see text] concentration have a significant impact on outpatient visits. The model built has excellent predictive performance and can provide some references for the scientific management of hospitals to allocate staff and resources.
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Affiliation(s)
- Lu Bai
- grid.263761.70000 0001 0198 0694Department of Biostatistics, School of Public Health, Medical College of Soochow University, Suzhou, 215123 China ,grid.263761.70000 0001 0198 0694Jiangsu Key Laboratory of Preventive and Translational Medicine for Geriatric Diseases, Medical College of Soochow University, Suzhou, 215123 China
| | - Ke Lu
- grid.452273.50000 0004 4914 577XDepartment of Orthopedics, Affiliated Kunshan Hospital of Jiangsu University, No. 91 West of Qianjin Road, Suzhou, 215300 Jiangsu China
| | - Yongfei Dong
- grid.263761.70000 0001 0198 0694Department of Biostatistics, School of Public Health, Medical College of Soochow University, Suzhou, 215123 China ,grid.263761.70000 0001 0198 0694Jiangsu Key Laboratory of Preventive and Translational Medicine for Geriatric Diseases, Medical College of Soochow University, Suzhou, 215123 China
| | - Xichao Wang
- grid.263761.70000 0001 0198 0694Department of Biostatistics, School of Public Health, Medical College of Soochow University, Suzhou, 215123 China ,grid.263761.70000 0001 0198 0694Jiangsu Key Laboratory of Preventive and Translational Medicine for Geriatric Diseases, Medical College of Soochow University, Suzhou, 215123 China
| | - Yaqin Gong
- grid.452273.50000 0004 4914 577XInformation Department, Affiliated Kunshan Hospital of Jiangsu University, Suzhou, 215300 Jiangsu China
| | - Yunyu Xia
- Meteorological Bureau of Kunshan City, Suzhou, 215337 Jiangsu China
| | - Xiaochun Wang
- Meteorological Bureau of Kunshan City, Suzhou, 215337 Jiangsu China
| | - Lin Chen
- Ecology and Environment Bureau of Kunshan City, Suzhou, 215330 Jiangsu China
| | - Shanjun Yan
- Ecology and Environment Bureau of Kunshan City, Suzhou, 215330 Jiangsu China
| | - Zaixiang Tang
- Department of Biostatistics, School of Public Health, Medical College of Soochow University, Suzhou, 215123, China. .,Jiangsu Key Laboratory of Preventive and Translational Medicine for Geriatric Diseases, Medical College of Soochow University, Suzhou, 215123, China.
| | - Chong Li
- Department of Orthopedics, Affiliated Kunshan Hospital of Jiangsu University, No. 91 West of Qianjin Road, Suzhou, 215300, Jiangsu, China.
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15
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Adhikari S, Titus AR, Baum A, Lopez P, Kanchi R, Orstad SL, Elbel B, Lee DC, Thorpe LE, Schwartz MD. Disparities in routine healthcare utilization disruptions during COVID-19 pandemic among veterans with type 2 diabetes. BMC Health Serv Res 2023; 23:41. [PMID: 36647113 PMCID: PMC9842402 DOI: 10.1186/s12913-023-09057-8] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/10/2022] [Accepted: 01/10/2023] [Indexed: 01/18/2023] Open
Abstract
BACKGROUND While emerging studies suggest that the COVID-19 pandemic caused disruptions in routine healthcare utilization, the full impact of the pandemic on healthcare utilization among diverse group of patients with type 2 diabetes is unclear. The purpose of this study is to examine trends in healthcare utilization, including in-person and telehealth visits, among U.S. veterans with type 2 diabetes before, during and after the onset of the COVID-19 pandemic, by demographics, pre-pandemic glycemic control, and geographic region. METHODS We longitudinally examined healthcare utilization in a large national cohort of veterans with new diabetes diagnoses between January 1, 2008 and December 31, 2018. The analytic sample was 733,006 veterans with recently-diagnosed diabetes, at least 1 encounter with veterans administration between March 2018-2020, and followed through March 2021. Monthly rates of glycohemoglobin (HbA1c) measurements, in-person and telehealth outpatient visits, and prescription fills for diabetes and hypertension medications were compared before and after March 2020 using interrupted time-series design. Log-linear regression model was used for statistical analysis. Secular trends were modeled with penalized cubic splines. RESULTS In the initial 3 months after the pandemic onset, we observed large reductions in monthly rates of HbA1c measurements, from 130 (95%CI,110-140) to 50 (95%CI,30-80) per 1000 veterans, and in-person outpatient visits, from 1830 (95%CI,1640-2040) to 810 (95%CI,710-930) per 1000 veterans. However, monthly rates of telehealth visits doubled between March 2020-2021 from 330 (95%CI,310-350) to 770 (95%CI,720-820) per 1000 veterans. This pattern of increases in telehealth utilization varied by community type, with lowest increase in rural areas, and by race/ethnicity, with highest increase among non-hispanic Black veterans. Combined in-person and telehealth outpatient visits rebounded to pre-pandemic levels after 3 months. Despite notable changes in HbA1c measurements and visits during that initial window, we observed no changes in prescription fills rates. CONCLUSIONS Healthcare utilization among veterans with diabetes was substantially disrupted at the onset of the pandemic, but rebounded after 3 months. There was disparity in uptake of telehealth visits by geography and race/ethnicity.
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Affiliation(s)
- Samrachana Adhikari
- Department of Population Health, New York University Grossman School of Medicine, 180 Madison Avenue, 4th Floor, #4-54, New York, NY, 10016, USA.
| | - Andrea R. Titus
- grid.137628.90000 0004 1936 8753Department of Population Health, New York University Grossman School of Medicine, 180 Madison Avenue, 4th Floor, #4-54, New York, NY 10016 USA
| | - Aaron Baum
- grid.59734.3c0000 0001 0670 2351Department of Global Health, Icahn School of Medicine at Mount Sinai, New York, NY USA
| | - Priscilla Lopez
- grid.137628.90000 0004 1936 8753Department of Population Health, New York University Grossman School of Medicine, 180 Madison Avenue, 4th Floor, #4-54, New York, NY 10016 USA
| | - Rania Kanchi
- grid.137628.90000 0004 1936 8753Department of Population Health, New York University Grossman School of Medicine, 180 Madison Avenue, 4th Floor, #4-54, New York, NY 10016 USA
| | - Stephanie L. Orstad
- grid.137628.90000 0004 1936 8753Department of Medicine, New York University Grossman School of Medicine, New York, NY USA
| | - Brian Elbel
- grid.137628.90000 0004 1936 8753Department of Population Health, New York University Grossman School of Medicine, 180 Madison Avenue, 4th Floor, #4-54, New York, NY 10016 USA ,grid.137628.90000 0004 1936 8753Wagner Graduate School of Public Service, New York University, New York, NY USA
| | - David C. Lee
- grid.137628.90000 0004 1936 8753Department of Population Health, New York University Grossman School of Medicine, 180 Madison Avenue, 4th Floor, #4-54, New York, NY 10016 USA ,grid.137628.90000 0004 1936 8753Ronald O. Perelman Department of Emergency Medicine, NYU Grossman School of Medicine, New York, NY USA
| | - Lorna E. Thorpe
- grid.137628.90000 0004 1936 8753Department of Population Health, New York University Grossman School of Medicine, 180 Madison Avenue, 4th Floor, #4-54, New York, NY 10016 USA
| | - Mark D. Schwartz
- grid.137628.90000 0004 1936 8753Department of Population Health, New York University Grossman School of Medicine, 180 Madison Avenue, 4th Floor, #4-54, New York, NY 10016 USA ,grid.413926.b0000 0004 0420 1627VA New York Harbor Healthcare System, New York, NY USA
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16
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Weiss SM, Castelo M, Liu B, Norris M. Virtual fall program assessment for frail Canadian community-dwelling older adults: Examining equitable accessibility. Digit Health 2023; 9:20552076231178410. [PMID: 37312948 PMCID: PMC10259118 DOI: 10.1177/20552076231178410] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/27/2022] [Accepted: 05/10/2023] [Indexed: 06/15/2023] Open
Abstract
Objective In response to COVID-19, the fall prevention program (FPP) at Sunnybrook Health Sciences Centre was modified to be delivered virtually. We compared patient populations assessed for the FPP virtually versus in-person to explore equitable accessibility. Methods A retrospective chart review was performed. All patients assessed virtually from the beginning of the COVID-19 pandemic until the end of abstraction (April 25, 2022) were compared to a historic sample of patients assessed in-person beginning in January 2019. Demographics, measures of frailty, co-morbidity, and cognition were abstracted. Wilcoxon Rank Sum tests and Fisher's Exact tests were used for continuous and categorical variables, respectively. Results Thirty patients were assessed virtually and compared to 30 in-person historic controls. Median age was 80 years (interquartile range 75-85), 82% were female, 70% were university educated, the median Clinical Frailty Score was 5 out of 9, and 87% used >5 medications. Once normalized, frailty scores showed no difference (p = 0.446). The virtual cohort showed significantly higher outdoor walking aid use (p = 0.015), reduced accuracy with clock drawing (p = 0.020), and nonsignificant trends toward using >10 medications, requiring assistance with >3 instrumental activities of daily living (IADLs), and higher treatment attendance. No significant differences were seen for time-to-treat (p = 0.423). Conclusion Patients assessed virtually were similarly frail as the in-person controls but had increased use of walking aids, medications, IADL assistance, and cognitive impairment. In a Canadian context, frail and high socioeconomic status older adults continued to access treatment through virtual FPP assessments during the COVID-19 pandemic highlighting both the benefits of virtual care and potential inequity.
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Affiliation(s)
- Sophie M. Weiss
- Temerty Faculty of Medicine, University of Toronto, Toronto, ON, Canada
| | - Matthew Castelo
- Institute of Health Policy, Management and Evaluation, Dalla Lana School of Public Health, University of Toronto, Toronto, ON, Canada
- Department of Surgery, University of Toronto, Toronto, ON, Canada
| | - Barbara Liu
- Division of Geriatric Medicine, University of Toronto Temerty Faculty of Medicine, Toronto, ON, Canada
- Division of Geriatric Medicine, Sunnybrook Health Sciences Centre, Toronto, ON, Canada
| | - Mireille Norris
- Division of Geriatric Medicine, University of Toronto Temerty Faculty of Medicine, Toronto, ON, Canada
- Division of Geriatric Medicine, Sunnybrook Health Sciences Centre, Toronto, ON, Canada
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17
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Schuttner L, Hockett Sherlock S, Simons CE, Johnson NL, Wirtz E, Ralston JD, Rosland AM, Nelson K, Sayre G. My Goals Are Not Their Goals: Barriers and Facilitators to Delivery of Patient-Centered Care for Patients with Multimorbidity. J Gen Intern Med 2022; 37:4189-4196. [PMID: 35606644 PMCID: PMC9126696 DOI: 10.1007/s11606-022-07533-1] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/27/2021] [Accepted: 03/29/2022] [Indexed: 01/04/2023]
Abstract
BACKGROUND Patient-centered care reflecting patient preferences and needs is integral to high-quality care. Individualized care is important for psychosocially complex or high-risk patients with multiple chronic conditions (i.e., multimorbidity), given greater potential risks of interventions and reduced benefits. These patients are increasingly prevalent in primary care. Few studies have examined provision of patient-centered care from the clinician perspective, particularly from primary care physicians serving in integrated, patient-centered medical home settings within the US Veterans Health Administration. OBJECTIVE We sought to clarify facilitators and barriers perceived by primary care physicians in the Veterans Health Administration to delivering patient-centered care for high-risk or complex patients with multimorbidity. DESIGN We conducted semi-structured telephone interviews from April to July 2020 among physicians across 20 clinical sites. Findings were analyzed with deductive content analysis based on conceptual models of patient-centeredness and hierarchical factors affecting care delivery. PARTICIPANTS Of 23 physicians interviewed, most were female (n = 14/23, 61%), serving in hospital-affiliated outpatient clinics (n = 14/23, 61%). Participants had a mean of 21 (SD = 11.3) years of experience. KEY RESULTS Facilitators included the following: effective physician-patient communication to individualize care, prioritize among multiple needs, and elicit goals to improve patient engagement; access to care, enabled by interdisciplinary teams, and dictating personalized care planning; effortful but worthwhile care coordination and continuity; meeting complex needs through effective teamwork; and integrating medical and non-medical care aspects in recognition of patients' psychosocial contexts. Barriers included the following: intra- and interpersonal (e.g., perceived patient reluctance to engage in care); organizational (e.g., limited encounter time); and community or policy impediments (e.g., state decisional capacity laws) to patient-centered care. CONCLUSIONS Physicians perceived individual physician-patient interactions were the greatest facilitators or barriers to patient-centered care. Efforts to increase primary care patient-centeredness for complex or high-risk patients with multimorbidity could focus on targeting physician-patient communication and reducing interpersonal conflict.
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Affiliation(s)
- Linnaea Schuttner
- Health Services Research & Development, VA Puget Sound Health Care System, Seattle, WA, USA. .,Department of Medicine, University of Washington School of Medicine, Seattle, USA.
| | - Stacey Hockett Sherlock
- Center for Access & Delivery Research and Evaluation (CADRE), VA Iowa City Health Care System, Iowa City, USA.,Carver College of Medicine, University of Iowa, Iowa City, USA
| | - Carol E Simons
- Health Services Research & Development, VA Puget Sound Health Care System, Seattle, WA, USA
| | - Nicole L Johnson
- Center for Access & Delivery Research and Evaluation (CADRE), VA Iowa City Health Care System, Iowa City, USA
| | - Elizabeth Wirtz
- Center for Access & Delivery Research and Evaluation (CADRE), VA Iowa City Health Care System, Iowa City, USA
| | - James D Ralston
- Kaiser Permanente Washington Health Research Institute, Seattle, USA.,Department of Health Systems and Population Health, University of Washington School of Public Health, Seattle, USA
| | - Ann-Marie Rosland
- Center for Health Equity Research and Promotion, VA Pittsburgh Healthcare System, Pittsburgh, USA.,Department of Medicine, University of Pittsburgh School of Medicine, Pittsburgh, USA
| | - Karin Nelson
- Health Services Research & Development, VA Puget Sound Health Care System, Seattle, WA, USA.,Department of Medicine, University of Washington School of Medicine, Seattle, USA
| | - George Sayre
- Health Services Research & Development, VA Puget Sound Health Care System, Seattle, WA, USA.,Department of Health Systems and Population Health, University of Washington School of Public Health, Seattle, USA
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18
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Wray CM. Post-Emergency Department Virtual Care-More Questions Than Answers. JAMA Netw Open 2022; 5:e2237790. [PMID: 36282506 DOI: 10.1001/jamanetworkopen.2022.37790] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/14/2022] Open
Affiliation(s)
- Charlie M Wray
- Department of Medicine, University of California, San Francisco
- Section of Hospital Medicine, San Francisco Veterans Affairs Medical Center, San Francisco, California
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