Healthcare Utilization During the COVID-19 Pandemic and the Supplementary Role of Telemedicine: Retrospective Study of Chronic Disease Cohorts (Preprint)

Abstract

The COVID-19 pandemic accelerated telehealth adoption among patients with a range of disease types. For many patients, routine medical care was no longer an option, and others chose not to visit medical offices in order to minimize COVID-19 exposure. In this study we take a comprehensive multi-disease approach in studying the impact of COVID-19 on healthcare utilization and the supplementary role of telemedicine through the first 12 months of the COVID-19 pandemic.

We study the impact of COVID-19 on in-person healthcare utilization across chronic diseases and the supplementary role of telehealth. We aim to further understand differences in telehealth adoption across patient demographics.

We conduct a retrospective cohort study of six different disease cohorts (anxiety n=69,673, depression n=45,979, diabetes n=83,562, kidney failure n= 29,861, heath failure n=21,600 and cancer n=35,937). We use summary statistics to characterize changes in utilization and regression analysis to study how patient characteristics relate to in-person healthcare and telehealth utilization during the first 12 months of the pandemic.

We observe a reduction in in-person healthcare utilization across disease cohorts. For most diseases we study, telehealth appointments make up for the reduction in in-person visits. Further, for anxiety and depression, the increase in telehealth utilization exceeds the reduction in in-person visits. We observe that younger patients, Black patients and patients from higher-income zip codes have higher telehealth utilization after accounting for other covariates.

The COVID-19 pandemic affected healthcare utilization across diseases, and the role of telehealth in replacing in-person visits varies by disease cohort. Understanding these differences can inform current practices and provides opportunities to further guide modalities of in-person and telehealth visits. Critically, further study is needed to understand barriers to telehealth service utilization for patients in lower-income areas. A better understanding of the role of social determinants of health may lead to more support for patients and help individual healthcare providers improve access to care for patients with chronic conditions.