Disparities in Telemedicine Use Among Louisiana Medicaid Beneficiaries During the COVID-19 Pandemic

Callison, Kevin; Anderson, A. C.; Shao, Youlin; LaVeist, Thomas A.; Walker, Brigham

doi:10.1097/mlr.0000000000001795

Cited by 6 publications

(7 citation statements)

References 40 publications

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“…There is limited longitudinal evidence about the impact of pandemic-era telemedicine implementation on the quality of care and utilization for Medicaid beneficiaries and CHC patients. In 3 of the supplement’s research studies, researchers examine the impact of telemedicine implementation among vulnerable populations, including Medicaid beneficiaries, Medicare beneficiaries, and CHC patients 18–20. Callison et al18 used interrupted time series methods to examine telemedicine use among Medicaid beneficiaries before and during the pandemic and found that the outpatient service use disparities between White and Black Louisiana Medicaid beneficiaries, but gaps in telemedicine use occurred at the same time.…”

Section: Commentarymentioning

confidence: 99%

“…In 3 of the supplement’s research studies, researchers examine the impact of telemedicine implementation among vulnerable populations, including Medicaid beneficiaries, Medicare beneficiaries, and CHC patients 18–20. Callison et al18 used interrupted time series methods to examine telemedicine use among Medicaid beneficiaries before and during the pandemic and found that the outpatient service use disparities between White and Black Louisiana Medicaid beneficiaries, but gaps in telemedicine use occurred at the same time. They also find that Latino beneficiaries had large reductions in outpatient service use and relatively small increases in telemedicine use compared with other populations, consistent with past research that highlights barriers to care due to limited English language proficiency 3,12,13…”

Section: Commentarymentioning

confidence: 99%

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Assessing the Impact of Telemedicine Implementation in Diverse Health Care Systems

Rodríguez

2023

Medical Care

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Health care organizations and systems can have a large impact on how extensively telemedicine and virtual visits are used by medical practices and individual clinicians. This supplemental issue of medical care aims to advance evidence about how health care organizations and systems can best support telemedicine and virtual visit implementation. This issue includes 10 empirical studies examining the impact of telemedicine on quality of care, utilization, and/or patient care experiences, of which 6 are studies of Kaiser Permanente patients; 3 are studies of Medicaid, Medicare, and community health center patients; and 1 is a study of PCORnet primary care practices. The Kaiser Permanente studies find that ancillary service orders resulting from telemedicine encounters were not placed as often as in-person encounters for urinary tract infections, neck, and back pain, but there were no significant changes in patient fulfillment of ordered antidepressant medications. Studies focused on diabetes care quality among community health center patients and Medicare and Medicaid beneficiaries highlight that telemedicine helped maintain continuity of primary care and diabetes care quality during the COVID-19 pandemic. The research findings collectively demonstrate high variation in telemedicine implementation across systems and the important role that telemedicine had in maintaining the quality of care and utilization for adults with chronic conditions when in-person care was less accessible.

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Section: Commentarymentioning

confidence: 99%

Section: Commentarymentioning

confidence: 99%

Assessing the Impact of Telemedicine Implementation in Diverse Health Care Systems

Rodríguez

2023

Medical Care

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“…18,[24][25][26] Louisiana has a high incidence of T2D and a significant proportion of low-income individuals enrolled in Medicaid. While several studies have examined telehealth trends during the pandemic, 16,27,28…”

Section: Introductionmentioning

confidence: 99%

“…Louisiana has a high incidence of T2D and a significant proportion of low‐income individuals enrolled in Medicaid. While several studies have examined telehealth trends during the pandemic, 16,27,28 sparse evidence addresses telehealth use and related factors among the low‐income population with T2D, who typically face more barriers to diabetes care. Understanding the trends and factors associated with telehealth use in this population is critical to inform strategies that promote equitable access to care and improve health outcomes.…”

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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“…[15][16][17] Although studies have examined glycaemic control following the use of telehealth during the pandemic in other countries, 18,19 realworld evidence in the United States is limited and we previously only examined its impact in a Medicare population and Medicaid population. [20][21][22][23][24] Telehealth utilization has significantly increased since March 2020 and has remained elevated compared with pre-pandemic levels. 22,[25][26][27][28] The high prevalence of diabetes in Louisiana, combined with the rapid adoption of telehealth, presents a unique opportunity to assess the impact of telehealth on diabetes care during the pandemic compared to traditional in-person care.…”

mentioning

confidence: 99%

Telehealth use and its impact on clinical outcomes in patients with type 2 diabetes during the COVID‐19 pandemic

Shao,

Shi,

Nauman

et al. 2023

Diabetes Obesity Metabolism

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AimTo evaluate the impact of telehealth use during the COVID‐19 pandemic on glycaemic control and other clinical outcomes among patients with type 2 diabetes.MethodsWe used electronic health records from the Research Action for Health Network (REACHnet) database for patients with type 2 diabetes who had telehealth visits and those who only received in‐person care during the pandemic. A quasi‐experimental method of difference‐in‐difference with propensity‐score weighting was implemented to mitigate selection bias and to control for observed factors related to telehealth use. Outcomes included glycated haemoglobin (HbA1c) and other clinical measures (low‐density lipoprotein [LDL] cholesterol, blood pressure [BP], and body mass index [BMI]).ResultsPatients using telehealth had better HbA1c control compared to those receiving in‐person care only during the pandemic. The telehealth group saw a significant average decrease of 0.146% (95% confidence interval [CI] −0.178% to −0.1145%; P < 0.001) in HbA1c levels over time. The proportion of patients with average HbA1c levels >7% decreased by 0.023 (95% CI −0.034, −0.011; P < 0.001) in the treatment group relative to the comparison group. Modest benefits in the control of LDL cholesterol levels, diastolic BP, and BMI were found in association with telehealth use.ConclusionsOur findings suggest that telehealth services contributed to better glycaemic control and management of other clinical outcomes in patients with type 2 diabetes during the pandemic. Factors unmeasured in this study would need to be further explored to better understand the impact of telehealth.

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Disparities in Telemedicine Use Among Louisiana Medicaid Beneficiaries During the COVID-19 Pandemic

Cited by 6 publications

References 40 publications

Assessing the Impact of Telemedicine Implementation in Diverse Health Care Systems

Assessing the Impact of Telemedicine Implementation in Diverse Health Care Systems

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

Telehealth use and its impact on clinical outcomes in patients with type 2 diabetes during the COVID‐19 pandemic

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