Abstract
Abstract
Background
Chronic kidney disease (CKD) is a common condition with adverse health outcomes addressable by early disease management. The impact of the COVID-19 pandemic on care utilization for the CKD population is unknown.
Objective
To examine pandemic CKD care and identify factors associated with a high care deficit.
Design
Retrospective observational study
Participants
248,898 insured individuals (95% Medicare Advantage, 5% commercial) with stage G3–G4 CKD in 2018
Main Measures
Predicted (based on the pre-pandemic period of January 1, 2019–February 28, 2020) to observed per-member monthly face-to-face and telehealth encounters, laboratory testing, and proportion of days covered (PDC) for medications, evaluated during the early (March 1, 2020–June 30, 2020), pre-vaccine (July 1, 2020–December 31, 2020), and late (January 2021–August 2021) periods and overall.
Key Results
In-person encounters fell by 24.1% during the pandemic overall; this was mitigated by a 14.2% increase in telehealth encounters, resulting in a cumulative observed utilization deficit of 10% relative to predicted. These reductions were greatest in the early pandemic period, with a 19.8% cumulative deficit. PDC progressively decreased during the pandemic (range 9–20% overall reduction), with the greatest reductions in hypertension and diabetes medicines. CKD laboratory monitoring was also reduced (range 11.8–43.3%). Individuals of younger age (OR 1.63, 95% CI 1.16, 2.28), with commercial insurance (1.43, 95% CI 1.25, 1.63), residing in the Southern US (OR 1.17, 95% CI 1.14, 1.21), and with stage G4 CKD (OR 1.21, 95% CI 1.17, 1.26) had greater odds of a higher care deficit overall.
Conclusions
The early COVID-19 pandemic resulted in a marked decline of healthcare services for individuals with CKD, with an incomplete recovery during the later pandemic. Increased telehealth use partially compensated for this deficit. The downstream impact of CKD care reduction on health outcomes requires further study, as does evaluation of effective care delivery models for this population.
Publisher
Springer Science and Business Media LLC
Reference38 articles.
1. Chronic Kidney Disease in the United States, 2021. Published June 15, 2021. https://www.cdc.gov/kidneydisease/publications-resources/ckd-national-facts.html. Accessed 9 July 2021.
2. Annual Data Report. USRDS. https://adr.usrds.org/2020/chronic-kidney-disease/1-ckd-in-the-general-population. Accessed 9 July 2021.
3. Annual Data Report. USRDS. https://adr.usrds.org/2020/chronic-kidney-disease/6-healthcare-expenditures-for-persons-with-ckd. Accessed 9 July 2021.
4. Chronic Kidney Disease and Mortality Risk: A Systematic Review | American Society of Nephrology. https://jasn.asnjournals.org/content/17/7/2034. Accessed 9 July 2021.
5. Tonelli M, Wiebe N, Guthrie B, et al. Comorbidity as a driver of adverse outcomes in people with chronic kidney disease. Kidney Int 2015;88:859-66.
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