A cross‐sectional study of telemedicine use during the COVID‐19 pandemic in people with Alzheimer’s disease
Anisha M Patel, Robert Schuldt, Denise M Boudreau, Nikki Win, Bryan R Cobb, Marisa McGinley- Psychiatry and Mental health
- Cellular and Molecular Neuroscience
- Geriatrics and Gerontology
- Neurology (clinical)
- Developmental Neuroscience
- Health Policy
- Epidemiology
Abstract
Background
People with Alzheimer’s disease (pwAD) may struggle to access medical care due to declining cognitive function. Telemedicine (TM) provides timely, remote access to AD‐related health services. During the COVID‐19 pandemic, the use of TM increased; however, it is unclear how its use and accessibility vary among commercially insured pwAD.
Method
This cross‐sectional study used US PharMetrics Plus commercial claims data (01/01/2019−12/31/2021). TM use, identified using ≥1 current procedural terminology code, was assessed in each pandemic year (2020 and 2021) in adults with ≥1 inpatient or ≥2 outpatient ICD‐10‐CM diagnosis codes for AD ≥30 days apart. Any TM use and AD‐related visits (AD diagnosis code in TM claim) were summarized, and characteristics of TM users vs nonusers among pwAD were described.
Result
Among pwAD, 48.3% (8948/18,513) in 2020 and 35.7% (7436/20,823) in 2021 used TM. Of these TM users, the mean (SD) number of TM claims was 2.8 (2.6) in 2020 and 2.7 (2.7) in 2021; approximately half had AD‐related TM visits (56.2% in 2020; 48.4% in 2021). Among pwAD, TM visits accounted for 3.0% of all healthcare claims in 2020 and 2.0% in 2021, and approximately a third of these claims were AD‐related (35.5% in 2020 and 32.9% in 2021). Most TM visits among pwAD included ≥1 interactive audio/video component (75.5% in 2020 and 77.8% in 2021) and involved an established patient visit (73.7% in 2020 and 75.3% in 2021). Of 44,303 total TM visits by pwAD in 2020 and 2021, 14.2% were provided by a neurologist. Compared with nonusers, TM users had a higher mean (SD) Charlson Comorbidity Index score (3 [2] vs 4 [2]), were less likely to be self‐insured (22.5% vs 18.1%) and were more likely to reside in western (18.5% vs 28.3%) or eastern (12.7% vs 17.1%) regions. TM use was highest in Massachusetts (83.2%) and California (78.9%).
Conclusion
Over a third of pwAD in a commercially insured population used TM during the pandemic; its use varied most notably by region and state and among those with a high comorbidity burden. Additional analyses will further inform TM access and its utility in pwAD.