Impact of Longitudinal Virtual Primary Care on Diabetes Quality of Care

Abstract

BACKGROUND: Lack of healthcare access to due to physician shortages is a significant driver of telemedicine expansion in rural areas. Telemedicine is effective for management of chronic conditions such as diabetes but its effectiveness in primary care settings is unknown. OBJECTIVE: To evaluate differences in diabetes care before and after implementation of a longitudinal virtual primary care program. DESIGN: Propensity score-matched cohort study utilizing difference-in-differences analysis. PARTICIPANTS: Patients with diabetes who received care at VA primary care clinics between January 2018 and December 2019 where the Virtual Integrated Multisite Patient Aligned Care Teams (V-IMPACT) program was implemented. EXPOSURE: Patient participation in at least one V-IMPACT visit while usual care patients did not participate in V-IMPACT. MAIN MEASURES: The primary outcome was change in hemoglobin A1C (HbA1C) and secondary outcomes included change in the proportion of patients meeting diabetes quality indicators: blood pressure control, statin use, angiotensin-converting enzyme inhibitors or angiotensin II receptor blockers (ACEi/ARB) use, and annual microalbuminuria testing. KEY RESULTS: Our propensity-matched cohort included 9010 patients split evenly between those who participated in V-IMPACT and those who remained in usual in-person care. Among individuals with diabetes who participated in V-IMPACT, the change in mean HbA1C was − 0.055% (95% CI − 0.088 to − 0.022%) while those in usual care had a − 0.047% (95% CI − 0.080 to − 0.014%) change before and after program implementation. We observed a 5.1% (95% CI 2.4 to 7.7%) absolute increase in the proportion prescribed statins in the V-IMPACT group, a 5.3% (95% CI 2.5 to 8.2%) increase prescribed ACE/ARBs, and a 4.6% (95% 1.7 to 7.5%) increase in completed yearly microalbuminuria testing. V-IMPACT was not associated with a significant difference in the proportion with controlled blood pressure at < 140/90 or < 130/90 mmHg thresholds. CONCLUSIONS: Quality of diabetes care delivered by a longitudinal virtual primary care model was similar if not better than traditional in-person care.

Association between telemedicine use and diabetes risk factor assessment and control in a primary care network

“…In contrast, prior studies have shown that telemedicine utilized as a supplement as opposed to a substitution for primary care, such as through remote patient monitoring, can improve diabetes risk factor measurements [ 23 – 27 ]. Future research should continue to explore how to best integrate these tools into primary care visits for diabetic patients [ 28 , 29 ].…”

Health System Resiliency and the COVID-19 Pandemic: A Case Study of a New Nationwide Contingency Staffing Program

“…To mitigate the impact of these shortages on patient access to care, VA implemented a regional healthcare delivery model as a national program in 2019 called Clinical Resource Hubs. CRHs emerged out of previous telehealth pilot programs that had demonstrated improved patient outcomes [ 18 ].…”

Survey of cancer screening practices and telehealth services among primary care physicians during the COVID-19 pandemic

“…Studies conducted in the United States both prior to and following COVID-19 evaluating adherence to evidence-based guidelines, blood pressure and Hemoglobin A1c, frequency of return visits, hospitalizations, and patient report experience have demonstrated non-inferior care for telemedicine as compared with in person care ( Flodgren et al, 2015(9):CD002098. , Smith et al, 2021 , Lu et al, 2021 , Zhang et al, 2021 , Halpren-Ruder et al, 2019 ). Patient reported satisfaction for telehealth services was high during COVID-19, however, patient satisfaction was higher for in person visits during this time based on studies conducted in New York City ( Ramaswamy et al, 2020 ).…”