Diabetes outcomes before and during telehealth advancements surrounding COVID-19

Abstract

Background Pharmacists can optimize outcomes related to diabetes mellitus (T2DM) by taking advantage of telehealth opportunities despite the COVID-19 Public Health Emergency (COVID-19 PHE). Objective Identify and compare changes in T2DM outcomes prior to (August 2019 through February 2020) and during (March 2020 through October 2020) the COVID-19 PHE. Secondary objectives were to identify and compare pay-for-performance metrics and additional fee-for-service submitted in these patients. Methods This study examined changes in T2DM outcomes at one primary care office within a community health system. Pharmacists started regularly using Remote Patient Monitoring (RPM) services during the COVID-19 PHE to reduce in-person visits. Patients with an initial A1C greater than or equal to 8% were included. Data collected included comorbidities, change in A1C, and diabetes and statin medication therapy adherence. Percentage of Healthcare Effectiveness Data and Information Set (HEDIS) and Merit-Based Incentive Payment System (MIPS) measures met, and billing code frequencies were also assessed. Results In the pre COVID-19 PHE group (N=30), the average three and six month A1C reductions were 1.3% and 1.2%, respectively, while the reductions were 2.0% and 2.2% in the during COVID-19 PHE group (N=61). The percentage of patients appropriately initiated or maintained on statins was 96.2% in the pre COVID-19 PHE group versus 82.6% in the during COVID-19 PHE group. Related to HEDIS, statin adherence was 95.2% in the pre COVID-19 PHE group and 84.2% in the during COVID-19 PHE group while A1C control was 41.7% versus 54%, respectively. A1C control related to MIPS was 60% pre COVID-19 PHE versus 73.8% during the COVID-19 PHE. Diabetes medication adherence related to HEDIS and medication reconciliation related to MIPS was 100% for both groups. Conclusion Data demonstrates the opportunity for pharmacists to maintain and improve clinical outcomes related to T2DM despite the ongoing COVID-19 PHE through implementation of telephonic monitoring.

The Association of Telehealth Availability and Quality of Care Measures for Patients With Diabetes at Federally Qualified Health Centers: Retrospective Cohort Study

“…In contrast, decreases in measured blood pressure control may have resulted from the lack of standardized blood pressure documentation in EHRs during telehealth visits rather than poor control, although this was untestable in our data. While these findings fill an important evidence gap by focusing on Medicaid-enrolled FQHC patients, they are largely consistent with previous literature showing the potential for telehealth to improve access and some quality of care-sensitive outcomes in diabetic populations [8][9][10].…”

Impact of the COVID-19 Pandemic on the Effectiveness of a Metabolic Health Telemedicine Intervention for Weight Loss: A Propensity Score Matching Analysis

“…Our findings support other studies that suggested that digitally supported programs were effective alternatives in mitigating some of the negative behavioral and lifestyle effects of government-enforced public health measures ( 15 , 17 ). Likewise, telehealth can be considered a practical and efficacious healthcare delivery mode for chronic diseases during the COVID-19 pandemic ( 18 ).…”

“…These digitally delivered weight loss programs were effective in eliciting short-term weight loss during the pandemic ( 15 , 16 ). Furthermore, the pandemic also transformed the provision of medical care, especially in the management of various chronic diseases, by promoting the use and implementation of telemedicine ( 18 – 20 ).…”

Pharmacist-Managed Diabetes Programs: Improving Treatment Adherence and Patient Outcomes

“…Studies have found that both in-person and virtual visits have similar outcomes. 32 The majority of published pharmacist models generally focus on scheduled telephone visits with interventions focused on pharmacist-led telephonic clinics, post-discharge follow-up, laboratory monitoring, and medication counseling. 33 Pharmacists have integrated technology into their visits through different means.…”