ABSTRACT
Objectives: This study examines use of telemedicine services and health outcomes in patients with hypertension (HTN) in pre- and post-COVID 19 periods in the US. Method(s): A retrospective analysis, using Optum de-identified Electronic Health Record dataset, was done among hypertensive patients on Medicare plans in three different time periods: 1st Jan 2018 - 30th June 2018, 1st Jan - 30th June 2019, and 1st Jan - 30th June 2020 (first two time periods are pre-COVID 19 and the last one is post-COVID 19). The date of first EHR with mention of HTN diagnosis was considered index date. Study participants were categorized into those who used only telemedicine services (Telemedicine group);only other places of service like outpatient, inpatient, or office (Other POS group);and those who used both telemedicine and other places of service (Both POS groups). Patients were followed for 6-months post-index to determine use of anti-HTN medications, resource utilization, and healthcare outcomes. Result(s): Fewer than 100 patients in each study period belonged to Telemedicine group. Majority (55%) patients in 2018 (pre-COVID 19) belonged to Other POS group, but in 2020 (post-COVID 19) majority (61%) patients belonged to Both POS group. About 70% patients in each of three groups were prescribed anti-HTN drugs and adherence was >90%. About ~60% patients in Telemedicine group had 2-6 healthcare encounters while ~80% in Other POS group and ~95% in Both POS groups had >6 healthcare encounters during follow-up period. Significantly more patients in Both POS groups received anti-HTN nutritional counseling as compared to other two groups. Also, blood pressure was controlled in significantly higher percentage of patients in Both POS groups as compared to other two groups. Conclusion(s): Patients who use telemedicine and other places of service are more likely to receive anti-HTN nutritional counseling and have better blood pressure control. Copyright © 2022
ABSTRACT
Introduction: More than 300 million people have been vaccinated against Covid-19 in the United States. It is well known that breakthrough infections are common in vaccinated individuals. Depending upon patient age, immunity, comorbidities, drugs, and history of Covid-19, these infections could be mild or severe and, in some cases, may require hospitalization. Objectives: To study the rate of Covid-19 breakthrough infections and associated illness in individuals after receiving mRNA vaccine. Methods: De-identified administrative claims data between December 2020 to March 2021 were used to identify vaccinated individuals (≥18 years). The study considered vaccines that were available in the US at the time of study duration. The first vaccination date was defined as index. Members were followed for two months post index to identify Covid-19 breakthrough infections (as defined by CDC) occurring ≥14 days post index. Patients with continuous enrollment for 90 days post-index were included. Evidence of vaccination was identified using pharmacy claims, while medical claims were used to identify a breakthrough and associated acute respiratory illnesses. Descriptive analysis was conducted to identify patient demographics, geographic location and age and sex wise distribution. Results: A total of 772,222 members had at least one claim for Covid-19 vaccination. Of these, 4631 (males: 1795 and females: 2836) had breakthrough infections with 384 patients reporting associated acute respiratory illness (pneumonia: 213;Acute Respiratory Distress Syndrome: 18;Acute Bronchitis: 10;Upper and Lower Respiratory Tract Infections: 128 and 16, respectively). Conclusions: Unarguably, mass vaccination has helped in reducing the burden of Covid-19 infection. However, viral vaccines are known to provide limited protection and some people may still get infected. Further research is needed to understand nature of emergency visits and conditions that call for ICU or non-ICU hospitalizations