Impact of Using Telehealth in Primary Care on Healthcare Resource Utilization, Costs, and Medication Adherence in Diabetic Patients
Author(s)
Lincy Lal, PharmD, PhD1, Yunxi Zhang, PhD2, Saurabh Chandra, MD2, J. Mike Swint, PhD3;
1University of Texas SPH, Adjunct Faculty, Missouri City, TX, USA, 2University of Mississippi Medical Center, Jackson, MS, USA, 3University of Texas -Houston- School of Public Health, Houston, TX, USA
1University of Texas SPH, Adjunct Faculty, Missouri City, TX, USA, 2University of Mississippi Medical Center, Jackson, MS, USA, 3University of Texas -Houston- School of Public Health, Houston, TX, USA
Presentation Documents
OBJECTIVES: To assess the impact of telehealth utilization for primary care access on health care resource utilization (HCRU), costs, and medication adherence among participants diagnosed with diabetes.
METHODS: This retrospective cohort study analyzed Medicare claims data for adult patients diagnosed with diabetes in Mississippi from 2019 to 2021, who were continuously enrolled in Medicare Parts A, B, and D. Primary care utilization, with and without telehealth services, was assessed using a marginal structural model (MSM) through an inverse probability of treatment weights in conjunction with mixed-effects models approach to account for both time-invariant and time-varying covariates. Patients who used Medicare Part C or were entitled to coverage due to end-stage renal disease were excluded. Adherence, measured by the proportion of days covered, to antidiabetic, antihypertensive, and antilipidemic medications with respective comorbidities were calculated.
RESULTS: Among the total 60,970 patients, 25,090 (41.2%) utilized telehealth for primary care during 2019-2021. Most diabetes patients were aged 65-74 (48.12%), female (56.38%), White (69.47%), not enrolled in Medicaid (68.84%), and residing in rural (67.28%) areas. The mean (SD) Charles Comorbidity Index (CCI) was 3.82 (2.65). MSM results indicated that telehealth was associated with a significantly lower number of outpatient and inpatient visits, 30-day readmissions, and lower medical and pharmacy costs (p<0.001 for all), though the number of emergency room (ER) visits were similar (p=0.317). Additionally, primary care telehealth was associated with a 1.7% and a 0.6% increase in adherence to antihypertensive medication and antilipidemic medication, respectively, but a 2.3% decrease in antidiabetic medication adherence.
CONCLUSIONS: Access to primary care via telehealth results in lower HCRU and costs and presents a mixed picture of the impact on medication adherence to chronic medications. Future research is warranted to determine factors that would impact medication adherence in these patients accessing telehealth services.
METHODS: This retrospective cohort study analyzed Medicare claims data for adult patients diagnosed with diabetes in Mississippi from 2019 to 2021, who were continuously enrolled in Medicare Parts A, B, and D. Primary care utilization, with and without telehealth services, was assessed using a marginal structural model (MSM) through an inverse probability of treatment weights in conjunction with mixed-effects models approach to account for both time-invariant and time-varying covariates. Patients who used Medicare Part C or were entitled to coverage due to end-stage renal disease were excluded. Adherence, measured by the proportion of days covered, to antidiabetic, antihypertensive, and antilipidemic medications with respective comorbidities were calculated.
RESULTS: Among the total 60,970 patients, 25,090 (41.2%) utilized telehealth for primary care during 2019-2021. Most diabetes patients were aged 65-74 (48.12%), female (56.38%), White (69.47%), not enrolled in Medicaid (68.84%), and residing in rural (67.28%) areas. The mean (SD) Charles Comorbidity Index (CCI) was 3.82 (2.65). MSM results indicated that telehealth was associated with a significantly lower number of outpatient and inpatient visits, 30-day readmissions, and lower medical and pharmacy costs (p<0.001 for all), though the number of emergency room (ER) visits were similar (p=0.317). Additionally, primary care telehealth was associated with a 1.7% and a 0.6% increase in adherence to antihypertensive medication and antilipidemic medication, respectively, but a 2.3% decrease in antidiabetic medication adherence.
CONCLUSIONS: Access to primary care via telehealth results in lower HCRU and costs and presents a mixed picture of the impact on medication adherence to chronic medications. Future research is warranted to determine factors that would impact medication adherence in these patients accessing telehealth services.
Conference/Value in Health Info
2025-05, ISPOR 2025, Montréal, Quebec, CA
Value in Health, Volume 28, Issue S1
Code
HSD61
Topic
Health Service Delivery & Process of Care
Disease
SDC: Diabetes/Endocrine/Metabolic Disorders (including obesity)