Patient factors associated with the offering of telehealth appointments from primary care physicians among Medicare Beneficiaries: Results from a national survey

Qu, Haiyan; Wei, Tina Ruoting; Islam, Shafiqul; Barnes, Garry; Schmidt, Kimberly; Knight, Joshua M.; Patel, Nihar G.

doi:10.1016/j.ijmedinf.2022.104822

Cited by 7 publications

(9 citation statements)

References 16 publications

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“…This pattern mirrored variations observed in beneficiaries’ overall use of telehealth services from 2019 to 2020 24 . Although rural–urban differences in Medicare members’ overall telehealth visit volume narrowed after the height of the pandemic, a significant gap persisted into 2021 46,56 . This gap, when taken together with results from the present study, provides fresh grounds for concern—now widespread among stakeholders and policy makers—that newly revised telehealth policies in Medicare could reinforce existing rural–urban disparities in MHS access 57–59 …”

Section: Discussionmentioning

confidence: 52%

Federal telehealth policy changes during the COVID‐19 public health emergency: Associations with telemental health use among rural and urban Medicare beneficiaries

Talbot

Burgess

Jonk

et al. 2023

The Journal of Rural Health

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PurposeThe COVID‐19 public health emergency (PHE) led to increased mental health (MH) concerns among Medicare beneficiaries while inhibiting their access to MH services (MHS). To help address these problems, the federal government introduced temporary flexibilities permitting broader telehealth use in Medicare. This study compared rural versus urban patterns of change in telemental health (TMH) use among adult MHS users in fee‐for‐service Medicare from 2019 to 2020, when PHE‐related telehealth expansions were enacted.MethodsIn this cross‐sectional investigation based on 2019–2020 Medicare claims data, we used chi‐square tests, t‐tests and adjusted logistic regression to explore how year (pre‐PHE vs. PHE), rurality, and beneficiary characteristics were related to TMH use.FindingsFrom 2019 to 2020, the proportion of MHS users who used TMH rose from 4.8% to 51.9% among rural residents (p < 0.0001) and from 1.1% to 61.3% (p < 0.0001) among urban residents. Across study years, adjusted odds of TMH use grew more than 18‐fold for rural MHS users (OR = 18.10, p < 0.001) and nearly 120‐fold for their urban counterparts (OR = 119.75, p < 0.001). Among rural MHS users in 2020, adjusted odds of TMH use diminished with increasing age.ConclusionsTMH mitigated PHE‐related barriers to MHS access for rural and urban beneficiaries, but urban residents benefited disproportionately. Among rural beneficiaries, older age was related to lower TMH use. To avoid reinforcing existing MHS access disparities, policies must address factors limiting TMH use among rural beneficiaries, especially those over 75 and those from historically underserved communities.

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Section: Discussionmentioning

confidence: 52%

Federal telehealth policy changes during the COVID‐19 public health emergency: Associations with telemental health use among rural and urban Medicare beneficiaries

Talbot

Burgess

Jonk

et al. 2023

The Journal of Rural Health

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“…Inflammation and damage to blood vessels and tissues, including those in the respiratory system, can result from high blood sugar levels, making it more difficult for the body to fight off infections 48 . The body's ability to mount an immune response against viral infections can be hindered by these comorbidities, which can disrupt the normal function of the immune system 49‐51 . The increased risk of pneumonia, ICU stay, intubation, and death among diabetic patients in the Mexican cohort may be explained by the weakened immune system and association with other comorbidities 52‐54 …”

Section: Discussionmentioning

confidence: 99%

“…48 The body's ability to mount an immune response against viral infections can be hindered by these comorbidities, which can disrupt the normal function of the immune system. [49][50][51] The increased risk of pneumonia, ICU stay, intubation, and death among diabetic patients in the Mexican cohort may be explained by the weakened immune system and association with other comorbidities. [52][53][54] The association between diabetes and worse outcomes in URIs has been attributed to a number of epidemiological explanations, one of which is COVID-19.…”

Section: Discussionmentioning

confidence: 99%

Hospitalized COVID‐19 patients with diabetes have an increased risk for pneumonia, intensive care unit requirement, intubation, and death: A cross‐sectional cohort study in Mexico in 2020

Huang

2023

Health Science Reports

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Background: Diabetes mellitus is a chronic health condition that has been linked with an increased risk of severe illness and mortality from COVID-19. In Mexico, the impact of diabetes on COVID-19 outcomes in hospitalized patients has not been fully quantified. Understanding the increased risk posed by diabetes in this patient population can help healthcare providers better allocate resources and improve patient outcomes. Objective: The objective of this study was to quantify the extent outcomes (pneumonia, intensive care unit [ICU] stay, intubation, and death) are worsened in diabetic patients with COVID-19. Methods: Between April 14, 2020 and December 20, 2020 (last accessed), data from the open-source COVID-19 database maintained by the Mexican Federal Government were examined. Utilizing hospitalized COVID-19 patients with complete outcome data, a retrospective cohort study (N = 402,388) was carried out. In relation to COVID-19, both univariate and multivariate logistic regression were used to investigate the effect of diabetes on specific outcomes. Results: The analysis included 402,388 adults (age >18) with confirmed hospitalized COVID-19 cases with mean age 46.16 (standard deviation = 15.55), 214,161 (53%) male. The outcomes delineated included pneumonia (N = 88,064; 22%), ICU

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“…[10][11][12][13][14][15][16] For instance, vulnerable populations such as ethnic minorities, low-income individuals and rural residents were less probable to use telehealth services, even after expanding coverage. [17][18][19][20][21][22][23] These disparities could be attributed to limited technological access in vulnerable populations. 18,[24][25][26] Louisiana has a high incidence of T2D and a significant proportion of low-income individuals enrolled in Medicaid.…”

Section: Introductionmentioning

confidence: 99%

“…However, despite the rapid increase in telehealth utilization during the pandemic, disparities in access and use persist across demographic and socioeconomic strata 10–16 . For instance, vulnerable populations such as ethnic minorities, low‐income individuals and rural residents were less probable to use telehealth services, even after expanding coverage 17–23 . These disparities could be attributed to limited technological access in vulnerable populations 18,24–26 …”

Section: Introductionmentioning

confidence: 99%

Trends and disparities in telehealth use among Louisiana Medicaid beneficiaries with type 2 diabetes

Shao

Shi

Nauman

et al. 2023

Diabetes Obesity Metabolism

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Aim: To examine trends in telehealth use among Medicaid beneficiaries with type 2 diabetes (T2D) before and during the coronavirus disease 2019 pandemic and identify factors related to telehealth use. Methods:We compared monthly proportions of outpatient visits delivered by telehealth by race/ethnicity, geography and age among Louisiana Medicaid beneficiaries with T2D using claims data from January 2018 to August 2021. We also examined the changes in provider types delivering telehealth. Multivariable logistic regression was conducted to identify individual level and zip code-level factors associated with telehealth use during the COVID-19 pandemic. Results:The monthly proportion of outpatient visits delivered by telehealth was low (< 1%) before the pandemic, spiked in April 2020 (> 15%), then remained at approximately 5%. Telehealth use varied across different racial/ethnic groups, geography and age groups over years. Older beneficiaries were less probable to use telehealth during the pandemic (adjusted odds ratio [AOR] = 0.874, 95% confidence interval[CI]: 0.831-0.919). Females used more telehealth than males (AOR = 1.359, 95% CI:1.298-1.423). Black beneficiaries used more telehealth than White beneficiaries (AOR = 1.067, 95% CI: 1.000-1.139). More telehealth services were used by Medicaid beneficiaries who were living in urban areas, with more primary care utilization, and with more chronic conditions at baseline. Conclusions:We found disparities in the uptake of telehealth during the COVID-19 pandemic, but they might have been narrowed for some groups (Hispanic and rural) among Louisiana Medicaid beneficiaries with T2D. Future studies should explore strategies to improve access to telehealth services and reduce related disparities for the low-income population.

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Patient factors associated with the offering of telehealth appointments from primary care physicians among Medicare Beneficiaries: Results from a national survey

Cited by 7 publications

References 16 publications

Federal telehealth policy changes during the COVID‐19 public health emergency: Associations with telemental health use among rural and urban Medicare beneficiaries

Federal telehealth policy changes during the COVID‐19 public health emergency: Associations with telemental health use among rural and urban Medicare beneficiaries

Hospitalized COVID‐19 patients with diabetes have an increased risk for pneumonia, intensive care unit requirement, intubation, and death: A cross‐sectional cohort study in Mexico in 2020

Trends and disparities in telehealth use among Louisiana Medicaid beneficiaries with type 2 diabetes

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