The availability of telemedicine during the COVID-19 pandemic improved access to endocrinology care for rural patients with type 2 diabetes and atherosclerotic cardiovascular disease, according to new research from the University of Pittsburgh and published today in JAMA Network Open.
Researchers analyzed the use of telemedicine for endocrinology and cardiology patients in association with sociodemographic and geographic variables during two-year time periods before and after the pandemic began. The data represented more than 9,000 patients in a large health system in Pennsylvania, spanning both rural and urban areas. In the pre-telemedicine era, prior to the pandemic, patients who lived furthe
r away from endocrinology clinics were less likely to receive care. That association weakened in the post-telemedicine era.
"These results are encouraging, because they mean that telemedicine has helped us reach some of our highest-risk patients," said lead author Margaret Zupa, M.D., M.S., assistant professor of medicine at Pitt and associate director of the Caring for Complex Chronic Conditions Research Center. "Without access to recommended treatment, these patients are at an increased risk of stroke, heart attack, and death."
Cardiovascular disease is the leading cause of death for patients with type 2 diabetes, which prompted researchers to also analyze the use of cardiology care. In this specialty, telemedicine did not appear to increase access to care based on a patient's distance to the nearest clinic. Instead, receipt of care was more closely linked to neighborhood walkability, race and cellular phone access.
"Because cardiology clinics and providers outnumber those in endocrinology, it is possible that increased in-person access meant that telemedicine uptake had less of an effect on access to cardiology," said Zupa.
During both periods, older patients were less likely to receive endocrinology care and Black patients were less likely to receive cardiology care. While more research is needed to better determine the reasons for these associations, this research provides a valuable first glimpse into the impact of pandemic-related telemedicine expansions on specialty care for this patient population.
"Patients who receive specialty care are more likely to achieve their treatment goals and experience fewer diabetes-related complications," said Zupa, also a UPMC endocrinologist who specializes in diabetes management. "We need to better understand and address barriers to care, whether they have to do with transportation, broadband access, discomfort with technology or something else."
Co-authors on the paper include Ann-Marie M. Rosland, M.D., M.S., Scott Dr. Rothenberger, Ph.D., Jessica G. Bauer, M.D., Yihao Zheng, M.S., and Ellen Kinnee, M.A., all of the University of Pittsburgh; and Amber E. Johnson of the University of Chicago.
This research was funded by the National Institutes of Health (UL1TR001857 & K23DK135794) and the Pittsburgh Foundation.
