ABSTRACT
BACKGROUNDTelehealth has emerged as an effective tool for managing common chronic conditions such as hypertension, especially during the COVID-19 pandemic. However, the impact of state telehealth payment and coverage parity laws on hypertension management remains uncertain. METHODSData from the MerativeTM MarketScan(R) Commercial Claims and Encounters Database from January 1, 2016 to December 31, 2021 were used to construct the study cohort. The sample included non-pregnant individuals aged 25-64 years with hypertension. We reviewed and coded telehealth parity laws related to hypertension management in all 50 states and the District of Columbia, distinguishing between payment parity laws and coverage parity laws. The primary outcomes were antihypertension medication use, measured by the average medication possession ratio (MPR), medication adherence (MPR [≥]80%), and average number of days of drug supply. We used a generalized difference-in-difference (DID) design to examine the impact of these laws. Results were presented as marginal effects and 95% confidence intervals (CI). RESULTSAmong 353,220 individuals, states with payment parity laws were significantly linked to increased average MPR by 0.43 percentage point (95% CI: 0.07 - 0.79), and an increase of 0.46 percentage point (95% CI: 0.06 - 0.92) in the probability of medication adherence. Payment parity laws also led to an average increase of 2.14 days (95% CI: 0.11 - 4.17) in antihypertensive drug supply, after controlling for state-fixed effects, year-fixed effects, individual sociodemographic characteristics and state time-varying covariates including unemployment rates, GDP per capita, and poverty rates. In contrast, coverage parity laws were associated with a 2.13-day increase (95% CI: 0.19 - 4.07) in days of drug supply, but did not significantly increase the average MPR or probability of medication adherence. In addition, telehealth payment or coverage parity laws were positively associated with the number of hypertension-related telehealth visits, but this effect did not reach statistical significance. These findings were consistent in sensitivity analyses. CONCLUSIONSState telehealth payment parity laws were significantly associated with greater medication adherence, whereas coverage parity laws were not. With the increasing adoption of telehealth parity laws across states, these findings may support policymakers in understanding potential implications on management of hypertension. Clinical Perspective What Is New?Telehealth is an effective tool to manage hypertension and state-level telehealth parity laws can influence its application. Prior studies have not clearly differentiated between the impacts of payment parity and coverage parity. Using a quasi-experimental generalized difference-in-differences design, we assessed the effects of telehealth payment parity and coverage parity laws on hypertension management. Our study found that state telehealth payment parity laws were significantly associated with increased hypertension medication adherence, while coverage parity laws were not. What Are the Clinical Implications?The widespread adoption of telehealth payment parity laws may significantly impact hypertension management, during emergencies like the COVID-19 pandemic and beyond. Considering that hypertension impacts approximately half of the adult population, our study provides valuable insights into the potential benefits of telehealth parity laws for private payers in enhancing the management of hypertension. With the increasing adoption of telehealth parity laws across states, integrating telehealth into hypertension management holds significant implications for the evolving U.S. healthcare system in the digital age.
Subject(s)
COVID-19ABSTRACT
Background: The outbreak of coronavirus disease in 2019 (COVID-19) has had an enormous impact on people’s health, and profoundly changed our lives and society. However, the impact of pandemic-related home confinement on children’s life and their mental health remains unknown. We took advantage of a natural experiment due to the onset of COVID-19 and examined this issue in two consecutive cohorts. Methods: This study compared mental health, family environment and lifestyles of two representative cohorts of young children in Shanghai, China. Both prospective cohorts recruited children at entry to kindergarten. Surveys were conducted at both entry and graduation of kindergarten using the same assessment instruments. Children in the non-exposed cohort experienced a normal period of kindergarten study and graduated in June, 2019; those in the exposed cohort were under confinement for five months and graduated in June, 2020. Findings: Compared with the non-exposed cohort, the exposed cohort had a significant increased percentage of children classified as “at-risk for mental health problems”, with an adjusted absolute risk difference of 3·1% (95% CI, 1·9% to 4·4%) for total difficulties as measured by the Strength and Difficulty Questionnaire. The effect of pandemic related confinement on mental health was larger in children with lower parental education. The exposed cohort had longer media time, sleep duration and a less favorable home environment. Interpretation: The pandemic related confinement negatively affected children's mental health and home environment. Strategies and actions are urgently needed to improve parenting skills and mitigate the negative impact by strengthening the family environment.Funding Statement: National Natural Science Foundation of China, Shanghai Committee of Science and Technology, Shanghai Municipal Health Commission, Shanghai Education CommitteeDeclaration of Interests: We declare no competing interests.Ethics Approval Statement: The study was approved by the Institutional Review Board of the Shanghai Children’s Medical Center, the Shanghai Jiao Tong University School of Medicine (SCMCIRB-K2016022-01)