Duke University School of Medicine, Durham, NC, USA.
Optum Labs, Minnetonka, MN, USA.
J Gen Intern Med. 2022 Dec;37(16):4241-4247. doi: 10.1007/s11606-022-07805-w. Epub 2022 Sep 26.
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.
背景：慢性肾脏病（CKD）是一种常见病症，通过早期疾病管理可以改善其不良健康结局。但 COVID-19 大流行对 CKD 患者的护理利用情况的影响尚不清楚。 目的：调查大流行期间的 CKD 护理情况，并确定与高护理缺陷相关的因素。 设计：回顾性观察性研究 参与者：2018 年有 G3-G4 期 CKD 的 248898 名参保人（95%医疗保险优势计划，5%商业保险） 主要措施：根据 2019 年 1 月 1 日至 2020 年 2 月 28 日的大流行前时期预测（基于大流行前时期的 1 月 1 日至 2 月 28 日），评估大流行期间（2020 年 3 月 1 日至 6 月 30 日）、疫苗接种前（2020 年 7 月 1 日至 12 月 31 日）和后期（2021 年 1 月至 2021 年 8 月）每个成员每月面对面和远程医疗就诊、实验室检测以及药物覆盖天数（PDC）的实际与预测值之比。 主要结果：总体而言，大流行期间面对面就诊减少了 24.1%；这被远程医疗就诊增加 14.2%所缓解，导致相对于预测值的累计观察到的利用率缺陷为 10%。在大流行早期，降幅最大，累计降幅为 19.8%。大流行期间 PDC 逐渐下降（总体减少 9-20%），高血压和糖尿病药物的降幅最大。CKD 实验室监测也减少（减少 11.8-43.3%）。年龄较小的个体（OR 1.63，95%CI 1.16，2.28）、商业保险（1.43，95%CI 1.25，1.63）、居住在美国南部（OR 1.17，95%CI 1.14，1.21）和 G4 期 CKD（OR 1.21，95%CI 1.17，1.26）的个体，整体上更有可能出现更高的护理缺陷。 结论：COVID-19 大流行早期导致 CKD 患者的医疗服务明显减少，后期大流行期间并未完全恢复。远程医疗使用的增加部分弥补了这一缺陷。CKD 护理减少对健康结果的下游影响需要进一步研究，还需要评估针对这一人群的有效护理提供模式。
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