Annual wellness visits and care management before and after dialysis initiation

Virginia Wang,Sarah Hudson Scholle,Clarissa J Diamantidis,Matthew L Maciejewski,Valerie A Smith,Lindsay Zepel

doi:10.1186/s12882-021-02368-0

Abstract

IntroductionDemands of dialysis regimens may pose challenges for primary care provider (PCP) engagement and timely preventive care. This is especially the case for patients initiating dialysis adjusting to new logistical challenges and management of symptoms and existing comorbid conditions. Since 2011, Medicare has provided coverage for annual wellness visits (AWV), which are primarily conducted by PCPs and may be useful for older adults undergoing dialysis.MethodsWe used the OptumLabs® Data Warehouse to identify a cohort of 1,794 Medicare Advantage (MA) enrollees initiating dialysis in 2014–2017 and examined whether MA enrollees (1) were seen by a PCP during an outpatient visit and (2) received an AWV in the year following dialysis initiation.ResultsIn the year after initiating dialysis, 93 % of MA enrollees had an outpatient PCP visit but only 24 % received an annual wellness visit. MA enrollees were less likely to see a PCP if they had Charlson comorbidity scores between 0 and 5 than those with scores 6–9 (odds ratio (OR) = 0.59, 95 % CI: 0.37–0.95), but more likely if seen by a nephrologist (OR = 1.60, 95 % CI: 1.01–2.52) or a PCP (OR = 15.65, 95 % CI: 9.26–26.46) prior to initiation. Following dialysis initiation, 24 % of MA enrollees had an AWV. Hispanic MA enrollees were less likely (OR = 0.57, 95 % CI: 0.39–0.84) to have an AWV than White MA enrollees, but enrollees were more likely if they initiated peritoneal dialysis (OR = 1.54, 95 % CI: 1.07–2.23) or had an AWV in the year before dialysis initiation (OR = 4.96, 95 % CI: 3.88–6.34).ConclusionsAWVs are provided at low rates to MA enrollees initiating dialysis, particularly Hispanic enrollees, and represent a missed opportunity for better care management for patients with ESKD. Increasing patient awareness and provider provision of AWV use among dialysis patients may be needed, to realize better preventive care for dialysis patients.

Highlights

Demands of dialysis regimens may pose challenges for primary care provider (PCP) engagement and timely preventive care
In contrast to an annual physical exam or regular care visits, an Annual wellness visits (AWVs) is a patient visit with their physician to review and modify a personalized prevention plan based upon a health risk assessment, focused on preventing illness based on their current health and risk factors [4, 5]
MA care may be organized to patientcentered care models under expansion, compared to that of Medicare FFS. Building from this earlier literature, this study examines the use of PCP care management and receipt of AWVs in Medicare Advantage (MA) enrollees initiating dialysis in 2014–2017

Summary

Introduction

Demands of dialysis regimens may pose challenges for primary care provider (PCP) engagement and timely preventive care This is especially the case for patients initiating dialysis adjusting to new logistical challenges and management of symptoms and existing comorbid conditions. There is limited evidence on what amount of PCP involvement in dialysis patient care is optimal Central to building this evidence base is understanding patients’ actual patterns of care, including how patients initiating dialysis engage with PCPs. Central to building this evidence base is understanding patients’ actual patterns of care, including how patients initiating dialysis engage with PCPs This is important during the critical period just before and after initiating dialysis, when coordination between providers could help patients adjust to new logistical challenges and support management of symptoms and existing comorbid conditions. Since 2011, Medicare has provided coverage for AWVs at no cost to beneficiaries to improve access and receipt of primary care management

Methods

Results

Discussion

Conclusion