Department of General Internal Medicine, Bern University Hospital, Inselspital, University of Bern, Freiburgstrasse, 3010, Bern, Switzerland.
Institute of Primary Health Care (BIHAM), University of Bern, Bern, Switzerland.
J Gen Intern Med. 2022 Mar;37(4):870-877. doi: 10.1007/s11606-021-07301-7. Epub 2022 Jan 6.
The COVID-19 pandemic required a change in outpatient care delivery models, including shifting from in-person to virtual visits, which may have impacted care of vulnerable patients.
To describe the changes in management, control, and outcomes in older people with type 2 diabetes (T2D) associated with the shift from in-person to virtual visits.
In veterans aged ≥ 65 years with T2D, we assessed the rates of visits (in person, virtual), A1c measurements, antidiabetic deintensification/intensification, ER visits and hospitalizations (for hypoglycemia, hyperglycemia, other causes), and A1c level, in March 2020 and April-November 2020 (pandemic period). We used negative binomial regression to assess change over time (reference: pre-pandemic period, July 2018 to February 2020), by baseline Charlson Comorbidity Index (CCI; > 2 vs. <= 2) and A1c level.
Among 740,602 veterans (mean age 74.2 [SD 6.6] years), there were 55% (95% CI 52-58%) fewer in-person visits, 821% (95% CI 793-856%) more virtual visits, 6% (95% CI 1-11%) fewer A1c measurements, and 14% (95% CI 10-17%) more treatment intensification during the pandemic, relative to baseline. Patients with CCI > 2 had a 14% (95% CI 12-16%) smaller relative increase in virtual visits than those with CCI <= 2. We observed a seasonality of A1c level and treatment modification, but no association of either with the pandemic. After a decrease at the beginning of the pandemic, there was a rebound in other-cause (but not hypo- and hyperglycemia-related) ER visits and hospitalizations from June to November 2020.
Despite a shift to virtual visits and a decrease in A1c measurement during the pandemic, we observed no association with A1c level or short-term T2D-related outcomes, providing some reassurance about the adequacy of virtual visits. Further studies should assess the longer-term effects of shifting to virtual visits in different populations to help individualize care, improve efficiency, and maintain appropriate care while reducing overuse.
COVID-19 大流行要求改变门诊护理模式，包括从面对面就诊转为虚拟就诊，这可能会影响到弱势患者的护理。
描述与从面对面就诊转为虚拟就诊相关的老年 2 型糖尿病（T2D）患者管理、控制和结局的变化。
在年龄≥65 岁的退伍军人中，我们评估了 2020 年 3 月和 2020 年 4 月至 11 月（大流行期间）期间与 T2D 相关的就诊次数（面对面、虚拟）、A1c 测量、降糖方案调整（强化/弱化）、急诊就诊和住院（低血糖、高血糖、其他原因）以及 A1c 水平。我们使用负二项回归评估了随时间的变化（参考：大流行前时期，2018 年 7 月至 2020 年 2 月），并根据基线 Charlson 合并症指数（CCI；>2 与<=2）和 A1c 水平进行分层。
在 740602 名退伍军人中（平均年龄 74.2[6.6]岁），面对面就诊减少了 55%（95%CI 52-58%），虚拟就诊增加了 821%（95%CI 793-856%），A1c 测量减少了 6%（95%CI 1-11%），治疗强化增加了 14%（95%CI 10-17%）。与基线相比，CCI>2 的患者的虚拟就诊相对增加幅度较小，为 14%（95%CI 12-16%）。我们观察到 A1c 水平和治疗调整存在季节性，但与大流行无关。在大流行初期下降后，2020 年 6 月至 11 月期间，其他原因（而非低血糖和高血糖相关）的急诊就诊和住院有所反弹。
尽管在大流行期间转向虚拟就诊和 A1c 测量减少，但我们没有观察到与 A1c 水平或短期 T2D 相关结局有关的关联，这为虚拟就诊的充分性提供了一些保证。进一步的研究应评估在不同人群中转向虚拟就诊的长期影响，以帮助个体化护理、提高效率，并在减少过度治疗的同时保持适当的护理。
