Study: COVID-19 pandemic significantly reduced CKD care management
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Among patients with chronic kidney disease, use of in-person services was dramatically reduced during the early months of COVID-19 pandemic, which was followed by an incomplete rebound, according to presented data.
“Telehealth helped, but it only partially compensated for the reduction that we saw in utilization,” Clarissa Jonas Diamantidis, MD, MHS, said during her presentation at the National Kidney Foundation Spring Clinical Meetings, which was held as a virtual event.
Diamantidis presented results of a retrospective study that used United Health Group Medicare Advantage data of more than 10 million health care encounters of patients with CKD stage 3 and stage 4. The overall study cohort was predominantly patients with stage 3 CKD. Patients were categorized into either a claims cohort or a lab cohort. Both groups had Unitedhealth Care Medicare and commercial insurance, were continuously enrolled from January 2018 to June 2020 and had at least two CKD-related claims from January to December 2018.
Researchers studied the care during a pre-pandemic time frame, which was defined as Jan. 1, 2019 to Feb. 29, 2020, to predict outpatient and inpatient visits for a pandemic period of March 1 to June 30, 2020. They then compared the predicted and observed overall care utilization for in-person and telehealth visits during the pandemic time frame.
Based on pre-pandemic utilization data, researchers predicted 2.74 million in-person visits for the pandemic time frame. However, they found 1.56 million in-person visits, which was approximately a 44% reduction in overall utilization.
Diamantidis said telehealth visits increased rapidly in April and May 2020, and briefly equaled the number of in-person visits. However, the number of telehealth visits declined as in-person visits resumed in June 2020. Researchers found telehealth visits supplemented in-person care by 12.5% during the pandemic period.
“In summary, what that means is we saw a cumulative observed deficit of just over 30% relative to what was predicted for that time frame.”
Medications with the highest reduction were antihypertension or diabetes medications.
The most impacted procedures during the pandemic time frame were metabolic panels, urine albumin quantification and assay of urine creatinine, she said.
“The take-home message is that the pandemic can actually serve as a natural opportunity to review the impact of our traditional care models in CKD and allow us to distinguish which aspects are of high and low value to CKD outcomes,” Diamantidis told Healio Nephrology.
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Diamantidis C, et al. Missing care: The impact of the COVID-19 pandemic on CKD care. Presented at: National Kidney Foundation Spring Clinical Meetings (virtual meting); April 6-10, 2021.
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