Telehealth and Medicare Type 2 Diabetes Care Outcomes: Evidence From Louisiana.

BACKGROUND: At the onset of the COVID-19 pandemic, the Centers for Medicare and Medicaid Services broadened access to telehealth. This provided an opportunity to test whether diabetes, a risk factor for COVID-19 severity, can be managed with telehealth services. OBJECTIVE: The objective of this study was to examine the impacts of telehealth on diabetes control. RESEARCH DESIGN: A doubly robust estimator combined a propensity score-weighting strategy with regression controls for baseline characteristics using electronic medical records data to compare outcomes in patients with and without telehealth care. Matching on preperiod trajectories in outpatient visits and weighting by odds were used to ensure comparability between comparators. SUBJECTS: Medicare patients with type 2 diabetes in Louisiana between March 2018 and February 2021 (9530 patients with a COVID-19 era telehealth visit and 20,666 patients without one). MEASURES: Primary outcomes were glycemic levels and control [ie, hemoglobin A1c (HbA1c) under 7%]. Secondary outcomes included alternative HbA1c measures, emergency department visits, and inpatient admissions. RESULTS: Telehealth was associated with lower pandemic era mean A1c values [estimate=-0.080%, 95% confidence interval (CI): -0.111% to -0.048%], which translated to an increased likelihood of having HbA1c in control (estimate=0.013; 95% CI: 0.002-0.024; P<0.023). Hispanic telehealth users had relatively higher COVID-19 era HbA1c levels (estimate=0.125; 95% CI: 0.044-0.205; P<0.003). Telehealth was not associated with differences in the likelihood of having an emergency department visits (estimate=-0.003; 95% CI: -0.011 to 0.004; P<0.351) but was associated with more the likelihood of having an inpatient admission (estimate=0.024; 95% CI: 0.018-0.031; P<0.001). CONCLUSION: Telehealth use among Medicare patients with type 2 diabetes in Louisiana stemming from the COVID-19 pandemic was associated with relatively improved glycemic control.

Effectiveness of Incentivized Peer Referral to Increase Enrollment in a Community-Based Chlamydia Screening and Treatment Study Among Young Black Men.

OBJECTIVES: Young Black men are under-represented in sexual health services and research, a condition likely magnified during COVID-19 shutdowns due to disruption of STI screening and treatment services. We examined the effect of incentivized peer referral (IPR) increasing peer referral among young Black men in a community-based chlamydia screening program. METHODS: Young Black men in New Orleans, LA, age 15-26 years enrolled in a chlamydia screening program between 3/2018 and 5/2021 were included. Enrollees were provided with recruitment materials to distribute to peers. Starting July 28, 2020, enrollees were also offered a $5 incentive for each peer enrolled. Enrollment was compared before and after the incentivize peer referral program (IPR) was implemented using multiple time series analysis (MTSA). RESULTS: The percentage of men referred by a peer was higher during IPR compared to pre-IPR (45.7% vs. 19.7%, p < 0.001). After the COVID-19 shutdown was lifted, there were 2.007 more recruitments per week (p = 0.044, 95% CI (0.0515, 3.964)) for IPR, compared to pre-IPR. Overall, there was a trending increase in recruitments in the IPR era relative to the pre-IPR era (0.0174 recruitments/week, p = 0.285, 95% CI (- 0.0146, 0.0493)) with less recruitment decay during IPR compared to pre-IPR. CONCLUSIONS: IPR may be an effective means of engaging young Black men in community-based STI research and prevention programs, particularly when clinic access is limited. CLINICAL TRIALS REGISTRY SITE AND NUMBER: Clinicaltrials.gov identifier NCT03098329.

Moving the Needle: Association Between a Vaccination Reward Lottery and COVID-19 Vaccination Uptake in Louisiana.

OBJECTIVE: On June 17, 2021, Louisiana launched a lottery campaign to reward residents who received a COVID-19 vaccination. We investigated the association between the lottery and vaccination uptake by characteristics of parishes. METHODS: We constructed an interrupted time series based on daily parish-level data on COVID-19 vaccinations to analyze the association with the lottery. We used recursive partitioning to separate vaccination uptake due to the Delta variant from vaccination uptake due to the lottery and limited our study period to May 25 through July 20, 2021. We performed subanalyses that grouped parishes by political affiliation, hesitancy toward COVID-19 vaccines, race and ethnicity, and socioeconomic status to detect heterogeneous responses to the lottery by these characteristics. We ran models separately for parishes in the top and bottom tertiles of each sociodemographic indicator and used a z test to check for differences. RESULTS: The lottery was associated with an additional 1.03 (95% CI, 0.61-1.45; P < .001) first doses per parish per day. Comparing lottery impacts between top and bottom tertiles, we found significantly larger associations in parishes with lower vaccine hesitancy rates, higher percentage of Hispanic population, higher median annual household income, and more people with a college degree. CONCLUSIONS: Results suggest that the lottery was associated with increased COVID-19 vaccination uptake in Louisiana. However, larger associations were observed in parishes with an already higher likelihood of accepting vaccines, which raises equity issues about the opportunity created by the lottery and its effectiveness as a long-term behavioral incentive.

COVID-19 and Routine Childhood and Adolescent Immunizations: Evidence from Louisiana Medicaid.

The COVID-19 pandemic disrupted routine vaccinations for children and adolescents. However, it remains unclear whether the impact has been different for children and adolescents from low-income families. To address this, we compared monthly routine vaccination use per 1000 vaccine-eligible children and adolescents enrolled in Louisiana Medicaid in the years before (2017-2019) and during the COVID-19 pandemic (2020). Compared to the 2017-2019 average vaccination rates, we found a 28% reduction in measles, mumps, and rubella (MMR), a 35% reduction in human papillomavirus (HPV), and a 30% reduction in tetanus, diphtheria, pertussis (Tdap) vaccinations in 2020. Vaccine uptake was lower in April 2020 after the declaration of a state of emergency and in late summer when back-to-school vaccinations ordinarily occur. We found little evidence of recovery in later months. Our findings suggest that a substantial number of disadvantaged children may experience longer periods of vulnerability to preventable infections because of missed vaccinations.