ArticleBMC health services research2023
Disparities in routine healthcare utilization disruptions during COVID-19 pandemic among veterans with type 2 diabetes.
Article in BMC health services research, 2023. The graph could read no effect estimate from its abstract, so it casts no vote on the map. Cited by 9 papers.
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Who cites it
9 citing papers in PubMed.
- Changes in pediatric service utilization for depression and anxiety during the COVID-19 pandemic.BMC health services research · 2026Article
- Population-Level Health Intervention and Primary Care Quality for Veterans.JAMA network open · 2025Article
- Diabetes prevalence, awareness, and control in the United States, 2017-2023.Diabetes & metabolism · 2025Article
- COVID-related healthcare disruptions among older adults with multiple chronic conditions in New York City.BMC health services research · 2025Article
- Pandemic-driven healthcare disruptions and their disproportionate impact on patients with diabetes: evidence from Texas.Frontiers in public health · 2025Observational
- Impact of the COVID-19 pandemic on type 2 diabetes care and factors associated with care disruption in Kenya and Tanzania.Global health action · 2024Article
- Geographic, Patient, and VA Medical Center Variation in the Receipt and Mode of Primary Care in a National Sample of Veterans with Diabetes during 2020.Healthcare (Basel, Switzerland) · 2024Article
- Procedure Prioritization During a Nationwide Ban on Non-Urgent Healthcare: A Quasi-Experimental Retrospective Study of Hospital Data in Switzerland.Health services insights · 2024Article
- Diabetes, Dementia, and Disruptions in Health Care Use in 2020 for Low-Income Medicare Beneficiaries.The Journal of ambulatory care managementArticle
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Authors and funding
10 authors.
Funding
Abstract
backgroundWhile emerging studies suggest that the COVID-19 pandemic caused disruptions in routine healthcare utilization, the full impact of the pandemic on healthcare utilization among diverse group of patients with type 2 diabetes is unclear. The purpose of this study is to examine trends in healthcare utilization, including in-person and telehealth visits, among U.S. veterans with type 2 diabetes before, during and after the onset of the COVID-19 pandemic, by demographics, pre-pandemic glycemic control, and geographic region.
methodsWe longitudinally examined healthcare utilization in a large national cohort of veterans with new diabetes diagnoses between January 1, 2008 and December 31, 2018. The analytic sample was 733,006 veterans with recently-diagnosed diabetes, at least 1 encounter with veterans administration between March 2018-2020, and followed through March 2021. Monthly rates of glycohemoglobin (HbA1c) measurements, in-person and telehealth outpatient visits, and prescription fills for diabetes and hypertension medications were compared before and after March 2020 using interrupted time-series design. Log-linear regression model was used for statistical analysis. Secular trends were modeled with penalized cubic splines.
resultsIn the initial 3 months after the pandemic onset, we observed large reductions in monthly rates of HbA1c measurements, from 130 (95%CI,110-140) to 50 (95%CI,30-80) per 1000 veterans, and in-person outpatient visits, from 1830 (95%CI,1640-2040) to 810 (95%CI,710-930) per 1000 veterans. However, monthly rates of telehealth visits doubled between March 2020-2021 from 330 (95%CI,310-350) to 770 (95%CI,720-820) per 1000 veterans. This pattern of increases in telehealth utilization varied by community type, with lowest increase in rural areas, and by race/ethnicity, with highest increase among non-hispanic Black veterans. Combined in-person and telehealth outpatient visits rebounded to pre-pandemic levels after 3 months. Despite notable changes in HbA1c measurements and visits during that initial window, we observed no changes in prescription fills rates.
conclusionsHealthcare utilization among veterans with diabetes was substantially disrupted at the onset of the pandemic, but rebounded after 3 months. There was disparity in uptake of telehealth visits by geography and race/ethnicity.
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