Impact of COVID-19 pandemic on the continuity of care for dermatologic patients on systemic therapy during the period of strict lockdown

Racial and Ethnic Differences in Hypertension-Related Telehealth and In-Person Outpatient Visits Before and During the COVID-19 Pandemic Among Medicaid Beneficiaries

Background: Little is known about the trends and costs of hypertension management through telehealth among individuals enrolled in Medicaid. Methods: Using MarketScan® Medicaid database, we examined outpatient visits among people with hypertension aged 18-64 years. We presented the numbers of hypertension-related telehealth and in-person outpatient visits per 100 individuals and the proportion of hypertension-related telehealth outpatient visits to total outpatient visits by month, overall, and by race and ethnicity. For the cost analysis, we presented total and patient out-of-pocket (OOP) costs per visit for telehealth and in-person visits in 2021. Results: Of the 229,562 individuals, 114,445 (49.9%) were non-Hispanic White, 80,692 (35.2%) were non-Hispanic Black, 3,924 (1.71%) were Hispanic. From February to April 2020, the number of hypertension-related telehealth outpatient visits per 100 persons increased from 0.01 to 6.13, the number of hypertension-related in-person visits decreased from 61.88 to 52.63, and the proportion of hypertension-related telehealth outpatient visits increased from 0.01% to 10.44%. During that same time, the proportion increased from 0.02% to 13.9% for non-Hispanic White adults, from 0.00% to 7.58% for non-Hispanic Black adults, and from 0.12% to 19.82% for Hispanic adults. The average total and patient OOP costs per visit in 2021 were $83.82 (95% confidence interval [CI], 82.66-85.05) and $0.55 (95% CI, 0.42-0.68) for telehealth and $264.48 (95% CI, 258.87-269.51) and $0.72 (95% CI, 0.65-0.79) for in-person visits, respectively. Conclusions: Hypertension management via telehealth increased among Medicaid recipients regardless of race and ethnicity, during the COVID-19 pandemic. These findings may inform telehealth policymakers and health care practitioners.

Telemedicine impact on post-stroke outpatient follow-up in an academic healthcare network during the COVID-19 pandemic

BACKGROUND

The expansion of telemedicine associated with the COVID-19 pandemic has influenced outpatient medical care. The objective of our study was to determine the impact of telemedicine on post-acute stroke clinic follow-up.

METHODS

We retrospectively evaluated the impact of telemedicine in Emory Healthcare, an academic healthcare system of comprehensive and primary stroke centers in Atlanta, Georgia, on post-hospital stroke clinic follow-up. We compared the frequency of 90-day follow-up in a centralized subspecialty stroke clinic among patients hospitalized before the local COVID-19 pandemic (January 1, 2019- February 28, 2020), during (March 1- April 30, 2020) and after telemedicine implementation (May 1- December 31, 2020). A comparison was made across hospitals less than 1 mile, 10 miles, and 25 miles from the stroke clinic.

RESULTS

Of 1096 ischemic stroke patients discharged home or to a rehab facility during the study period, 342 (31%) had follow-up in the Emory Stroke Clinic (comprehensive stroke center 46%, primary stroke center 10 miles away 18%, primary stroke center 25 miles away 14%). Overall, 90-day follow-up increased from 19% to 41% after telemedicine implementation (p<0.001) with telemedicine appointments amounting for up to 28% of all follow-up visits. In multivariable analysis, factors associated with teleneurology follow-up (vs no follow-up) included discharge from the comprehensive stroke center, thrombectomy treatment, private insurance, private transport to the hospital, NIHSS 0-5 and history of dyslipidemia.

CONCLUSIONS

Despite telemedicine implementation at an academic healthcare network successfully increasing post-stroke discharge follow-up in a centralized subspecialty stroke clinic, the majority of patients did not complete 90-day follow-up during the COVID-19 pandemic.

Sleep loss and the skin: Possible effects of this stressful state on cutaneous regeneration during nocturnal dermatological treatment and related pathways

Cutaneous homeostasis can be modulated by sleep. Although there is little evidence about the efficacy of medications topically applied in the morning compared to those administered in the evening, they are commonly prescribed to be used overnight. Poor sleep may affect the tegument, but its repercussion on dermatological therapy is not clear. This communication aims to carry out an overview on the relationship between sleep and the skin, particularly in respect of the effectiveness of topical substances during the night versus the day; and the possible impact of sleep dysregulation on these treatments. Features related to this external organ, involving hydration, blood flow, and the permeability of the superficial barrier have physiological variations in sleep period. Our hypothesis is that sleep loss could alter drug absorption in the dermis and impair the success of the treatment. This can depend on the integrity of the mechanical skin barrier, and the enzymatic process after drug penetration, which may be influenced by the circadian rhythm. We raise the role of sleep disturbance in relation to skin aging and the cutaneous microbiota. The organ integrity and local immunology can be guided by sleep distress, which can modify the control of dermatological diseases. Future comparative analyses are warranted to explore the possible changes of the integumentary system influenced by circadian rhythm, and interference in response to topical dermal treatments. We emphasize the importance of sufficient sleep to improve the clinical management of several dermatosis and cosmetic complaints that need percutaneous therapeutics.

Oral isotretinoin treatment in patients with acne vulgaris during the COVID-19 pandemic: A retrospective cohort study in a tertiary care hospital

Background

Patients with acne vulgaris continue to present increasingly in dermatology outpatient clinics and seek treatment during the COVID‐19 pandemic. As far as we know, the effect of isotretinoin on COVID‐19 has not been studied before.

Aim

We aimed to evaluate whether patients receiving oral isotretinoin are at increased risk of COVID‐19 infection by comparing them with patients on topical treatment for acne vulgaris.

Methods

The data were collected retrospectively from a cohort of 267 acne vulgaris patients, who were under follow‐up for acne vulgaris treatment during the pandemic period.

Results

Total of 227 patients (141 receiving isotretinoin treatment and 86 receiving topical treatment) were included of whom 29 patients had COVID‐19 infection during acne vulgaris treatment. Fifteen (10.6%) patients were receiving oral isotretinoin and 14 (16.3%) were receiving topical acne treatment at the time of COVID‐19 infection. The mean cumulative dose was 2340 ± 1988 mg at the time of COVID‐19 infection. The mean elapsed time between the onset of isotretinoin treatment and positive PCR result for COVID‐19 was 13.3 ± 10.3 weeks. Nine patients (64.3%) receiving isotretinoin treatment and 9 patients (60%) under topical treatment had loss of taste and smell during COVID‐19 infection. Isotretinoin treatment was not found to be associated with a significant increased risk of getting COVID‐19 (odds ratio, 0.671; 95% confidence interval, 0.247–1.823; P  = 0.434).

Conclusion

As a conclusion, the results of this study encourage dermatologists and acne vulgaris patients to initiate oral isotretinoin treatment safely during the pandemic period.

Is systemic isotretinoin use a risk factor for coronavirus disease 2019 (COVID-19)?

Aim

To investigate whether acne treatment agent systemic isotretinoin causes susceptibility to COVID‐19 disease.

Material and method

Patients admitted to a single center due to acne between March 2020 and December 2020 were included. A retrospective analysis was conducted on the medical records of acne patients receiving systemic isotretinoin or topical treatments. The patients with PCR‐confirmed SARS‐CoV‐2 infection were recorded.

Results

302 patients who used isotretinoin and 329 patients who used topical treatment were included in the study. No statistically significant difference was found between the groups in terms of age (p = 0.151). It was found that of the 302 patients who used isotretinoin, 33 had PCR test for SARS‐CoV‐2 and two of these had PCR positivity, while of the 329 patients who received topical treatment, 45 had PCR test and five of these had PCR positivity. No statistically significant difference was found between the groups in terms of having SARS‐CoV‐2 positivity with PCR (p = 0.692).

Conclusion

Susceptibility to COVID‐19 disease was not observed in patients using systemic isotretinoin.