The Impact of Telehealth Adoption During COVID-19 Pandemic on Patterns of Pediatric Subspecialty Care Utilization

Cahan, Eli M.; Maturi, Jay; Bailey, Paige; Fernandes, Susan M.; Addala, Ananta; Kibrom, Sara; Krissberg, Jill R; Smith, Stephanie M.; Shah, Sejal; Wang, Ewen; Saynina, Olga; Wise, Paul H.; Chamberlain, Lisa

doi:10.1016/j.acap.2022.03.010

Cited by 13 publications

(7 citation statements)

References 29 publications

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“…The COVID-19 pandemic has been shown to negatively affect referral rates to specialty services for a variety of medical and surgical conditions 26–29 . We believe our study is the first to investigate the impact of COVID-19 on PCP referral rates to specialty providers for UI.…”

Section: Discussionmentioning

confidence: 90%

“…The COVID-19 pandemic has been shown to negatively affect referral rates to specialty services for a variety of medical and surgical conditions. [26][27][28][29] We believe our study is the first to investigate the impact of COVID-19 on PCP referral rates to specialty providers for UI. Although we found no significant reduction in the diagnosis of UI during the pandemic, there was a statistically significant decrease in referrals to specialist physicians.…”

Section: Discussionmentioning

confidence: 97%

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Referral and Prescription Patterns for Female Patients With Urinary Incontinence

Luebke,

Davidson,

Crotty

et al. 2023

UROGC

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Importance Although behavioral modifications, medications, and other interventions can improve urinary incontinence (UI), many women never receive them. Objectives To better characterize UI treatment patterns in primary care, we examined prescriptions and referrals to pelvic floor physical therapy (PFPT) and specialist physicians within a large Midwestern academic health system. Study Design Electronic health records were queried to identify a cohort of adult female patients receiving a new UI diagnosis during outpatient primary care visits from 2016 to 2020. Urinary incontinence referrals and referral completion were examined for the overall cohort, and medication prescriptions were examined for women with urgency or mixed UI. Logistic regression was used to assess the association of prescriptions and/or referrals with patient demographics, comorbidities, and UI diagnosis dates. Results In the year after primary care UI diagnosis, 37.2% of patients in the overall cohort (n = 4,382) received guideline-concordant care. This included 20.6% of women who were referred for further management: 17.7% to urology/urogynecology and 3.2% to PFPT. Most women who were referred attended an initial appointment. Among those with urgency (n = 2,398) or mixed UI (n = 552), 17.1% were prescribed medication. Women with stress (odds ratio [OR], 3.10; 95% CI, 2.53–3.79) and mixed UI (OR, 6.17; 95% CI, 4.03–9.66) were more likely to be referred for further management, and women diagnosed during the COVID-19 pandemic were less likely to be referred for further care (OR, 0.39; 95% CI, 0.29, 0.48). Conclusion Only slightly above 1 in 3 women with a new diagnosis of UI in primary care received guideline-based medications or referrals within 1 year, suggesting missed opportunities for timely care.

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Section: Discussionmentioning

confidence: 90%

Section: Discussionmentioning

confidence: 97%

Referral and Prescription Patterns for Female Patients With Urinary Incontinence

Luebke,

Davidson,

Crotty

et al. 2023

UROGC

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“…Issues with technological access and literacy may disproportionately limit non-English speakers and poorer patients in communicating their insurance information to their physician. 34 Conscious or unconscious physician biases may also play a role in this disparity. If physicians believe that minority patients are more likely to incorrectly convey their insurance information, they may attempt to avoid costly insurance reimbursement issues (eg, authorization requirements) for aflibercept and ranibizumab by treating patients with bevacizumab.…”

Section: Discussionmentioning

confidence: 99%

Effect of Race and Insurance Status on Treatment and Outcomes in Diabetic Retinopathy: Analysis of 43 274 Eyes Using the IRIS Registry

Maturi,

Scott

et al. 2024

Journal of VitreoRetinal Diseases

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Purpose: To examine disparities in visual acuity (VA) outcomes 1 year and 2 years after initiation of diabetic retinopathy (DR) or diabetic macular edema (DME) treatment in patients based on race/ethnicity and insurance status, accounting for disease severity. Methods: This retrospective analysis used the IRIS Registry and included DR patients older than 18 years with documented antivascular endothelial growth factor (anti-VEGF) treatment and VA data for at least 2 years. International Classification of Diseases, Tenth Revision, Clinical Modification codes were used to determine the severity of DR and DME presence. VA outcomes were assessed using multivariable linear regressions and anti-VEGF drug use by multivariable logistic regressions, with race and insurance status as independent variables. Main outcome measures comprised the mean VA change at 1 year and 2 years and percentage of patients treated with bevacizumab. Results: Among 43 274 eyes, White patients presented with a higher mean VA and lower mean DR severity than Black and Hispanic patients. Multivariable logistic regression showed Hispanic patients were significantly more likely to be treated with bevacizumab than White patients across all insurance types, controlling for disease severity and VA. After 1 year, the letter improvement was 1.73, 1.33, and 1.13 in White, Black, and Hispanic patients, respectively. Multivariable linear regression suggested that across races, Medicaid-insured patients had significantly smaller gains in VA than privately insured patients. Conclusion: Race-based and insurance-based differences in 1-year and 2-year outcomes after anti-VEGF treatment for DR and anti-VEGF treatment patterns suggest a need to ensure earlier and more effective treatment of minority and underserved patients nationally.

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“…During the COVID-19 pandemic, increase in telehealth utilization, where the endocrinology subspecialty provider engages in direct patient care and management, has become a more commonplace and well-accepted (13)(14)(15). While this model has been considered useful in increasing the access to subspecialty care, barriers to telehealth utilization have included limitations due to English proficiency, health literacy, technology access, and broadband/connectivity issues (16)(17)(18).…”

Section: Introductionmentioning

confidence: 99%

“…In addition to the shortage of pediatric and adult endocrinology providers, the incidence and prevalence of pediatric and adult diabetes is increasing which further exacerbates the access gap, particularly for underrepresented populations (22)(23)(24). The COVID-19 pandemic accelerated telehealth implementation for nearly all diagnoses such that telemedicine is now considered a standard modality for health care delivery (13,14,25,26). That said, telehealth alone is not sufficient to ensure access to standard of care for many individuals living with diabetes.…”

Section: Introductionmentioning

confidence: 99%

Tele-education model for primary care providers to advance diabetes equity: Findings from Project ECHO Diabetes

et al. 2022

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IntroductionIn the US, many individuals with diabetes do not have consistent access to endocrinologists and therefore rely on primary care providers (PCPs) for their diabetes management. Project ECHO (Extension for Community Healthcare Outcomes) Diabetes, a tele-education model, was developed to empower PCPs to independently manage diabetes, including education on diabetes technology initiation and use, to bridge disparities in diabetes.MethodsPCPs (n=116) who participated in Project ECHO Diabetes and completed pre- and post-intervention surveys were included in this analysis. The survey was administered in California and Florida to participating PCPs via REDCap and paper surveys. This survey aimed to evaluate practice demographics, protocols with adult and pediatric T1D management, challenges, resources, and provider knowledge and confidence in diabetes management. Differences and statistical significance in pre- and post-intervention responses were evaluated via McNemar’s tests.ResultsPCPs reported improvement in all domains of diabetes education and management. From baseline, PCPs reported improvement in their confidence to serve as the T1D provider for their community (pre vs post: 43.8% vs 68.8%, p=0.005), manage insulin therapy (pre vs post: 62.8% vs 84.3%, p=0.002), and identify symptoms of diabetes distress (pre vs post: 62.8% vs 84.3%, p=0.002) post-intervention. Compared to pre-intervention, providers reported significant improvement in their confidence in all aspects of diabetes technology including prescribing technology (41.2% vs 68.6%, p=0.001), managing insulin pumps (41.2% vs 68.6%, p=0.001) and hybrid closed loop (10.2% vs 26.5%, p=0.033), and interpreting sensor data (41.2% vs 68.6%, p=0.001) post-intervention.DiscussionPCPs who participated in Project ECHO Diabetes reported increased confidence in diabetes management, with notable improvement in their ability to prescribe, manage, and troubleshoot diabetes technology. These data support the use of tele-education of PCPs to increase confidence in diabetes technology management as a feasible strategy to advance equity in diabetes management and outcomes.

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The Impact of Telehealth Adoption During COVID-19 Pandemic on Patterns of Pediatric Subspecialty Care Utilization

Cited by 13 publications

References 29 publications

Referral and Prescription Patterns for Female Patients With Urinary Incontinence

Referral and Prescription Patterns for Female Patients With Urinary Incontinence

Effect of Race and Insurance Status on Treatment and Outcomes in Diabetic Retinopathy: Analysis of 43 274 Eyes Using the IRIS Registry

Tele-education model for primary care providers to advance diabetes equity: Findings from Project ECHO Diabetes

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