Access to telehealth and changes in diabetes care patterns during the pandemic: evidence from a large integrated health system in the Southeast USA.

Autor:	Oviedo SA; Department of Surgery, Emory University School of Medicine, Atlanta, Georgia, USA.; Department of Epidemiology, Rollins School of Public Health, Emory University, Atlanta, Georgia, USA., McDonald B; Kaiser Permanente Georgia, Atlanta, Georgia, USA., Gander JC; Kaiser Permanente Georgia, Atlanta, Georgia, USA., Ali MK; Family and Preventive Medicine, Hubert Department of Global Health, Emory University, Atlanta, Georgia, USA., Harding JL; Department of Surgery, Emory University School of Medicine, Atlanta, Georgia, USA jessica.harding@emory.edu.; Department of Epidemiology, Rollins School of Public Health, Emory University, Atlanta, Georgia, USA.
Jazyk:	angličtina
Zdroj:	BMJ open diabetes research & care [BMJ Open Diabetes Res Care] 2024 Feb 27; Vol. 12 (1). Date of Electronic Publication: 2024 Feb 27.
DOI:	10.1136/bmjdrc-2023-003882
Abstrakt:	Introduction: To examine the role of telehealth in diabetes care and management during versus pre-COVID-19 pandemic. Research Design and Methods: We included adults (≥18 years) with prevalent diabetes as of January 1, 2018, and continuously enrolled at Kaiser Permanente Georgia through December 31, 2021 (n=22,854). We defined pre (2018-2019) and during COVID-19 (2020-2021) periods. Logistic generalized estimating equations (GEEs) assessed the within-subject change in adherence to seven annual routine care processes (blood pressure (BP), hemoglobin A1C (HbA1c), cholesterol, creatinine, urine-albumin-creatinine ratio (UACR), eye and foot examinations) pre versus during COVID-19 among telehealth users (ie, more than one telehealth visit per year per period) and non-telehealth users. Linear GEE compared mean laboratory measurements pre versus during COVID-19 by telehealth use. Results: The proportion of telehealth users increased from 38.7% (2018-2019) to 91.5% (2020-2021). During (vs pre) the pandemic, adherence to all care processes declined in telehealth (range: 1.6% for foot examinations to 12.4% for BP) and non-telehealth users (range: 1.9% for foot examinations to 40.7% for BP). In telehealth users, average HbA1c (mean difference: 0.4% (95% CI 0.2% to 0.6%), systolic BP (1.62 mm Hg (1.44 to 1.81)), and creatinine (0.03 mg/dL (0.02 to 0.04)), worsened during (vs pre) COVID-19, while low density lipoprotein (LDL) cholesterol improved (-9.08 mg/dL (-9.77 to -8.39)). For UACR, odds of elevated risk of kidney disease increased by 48% (OR 1.48 (1.36-1.62)). Patterns were similar in non-telehealth users. Conclusions: Telehealth use increased during the pandemic and alleviated some of the observed declines in routine diabetes care and management. Competing Interests: Competing interests: None declared. (© Author(s) (or their employer(s)) 2024. Re-use permitted under CC BY-NC. No commercial re-use. See rights and permissions. Published by BMJ.)
Databáze:	MEDLINE
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