1017-P: Association between Early-Pandemic Primary Care Telemedicine Exposure and Ongoing HbA1c Outcomes

Abstract

Objective: Telemedicine helped maintain primary care access for patients with diabetes when in-person health visits were restricted early in the COVID-19 pandemic. There is little known about the longer-term impact of pandemic telemedicine on patient outcomes. Method: In an integrated health care system that temporarily shifted all patient-initiated primary care visits to telemedicine during the early pandemic, we used EHR data to compare patients with diabetes exposed to a primary care video or telephone telemedicine visit during the first year of the pandemic (4/2020-03/2021), and examined two outcome variables in second year of the pandemic (04/2021-03/2022): any HbA1c measured, and HbA1c <8%. Using multivariate logistic regression to examine the association between telemedicine exposure and outcomes, we adjusted for patient age, sex, race, language, neighborhood SES and internet, video visit and patient portal history, other comorbid chronic conditions, and baseline HbA1c, then calculated multivariate adjusted outcome rates. Results: Among 242,848 patients with diabetes, 49.8% were age 65+, 59.9% were of non-White race/ethnicity. During the first year of pandemic, 42% were exposed to a primary care video visit, 32% had only telephone visits (25% had no visits). The adjusted rate of HbA1c testing in the outcome period was 91% among those with a video or telephone visit, compared to 87% for those with no visit (p<0.05). Similarly, an adjusted 69% of those with a video visit had HbA1c <8% compared to 67% among patients with no visit (p<0.05), with stronger associations among patients with baseline HbA1c 8+. Conclusion: In patients with diabetes, primary care telemedicine exposure during the initial pandemic period was associated with downstream higher rates of HbA1c testing and greater rates of HbA1c’s within target range. Telemedicine primary care access likely supported continuity in diabetes management during the pandemic. Disclosure M.Reed: None. J.Huang: None. A.Millman: None. Funding National Institute of Diabetes and Digestive and Kidney Diseases (R01DK085070)