Trends and disparities in telehealth use among Louisiana Medicaid beneficiaries with type 2 diabetes

Abstract

Aim: To examine trends in telehealth use among Medicaid beneficiaries with type 2 diabetes (T2D) before and during the coronavirus disease 2019 (COVID-19) pandemic and identify factors related to telehealth use.

Methods: We compared monthly proportions of outpatient visits delivered by telehealth by race/ethnicity, geography and age among Louisiana Medicaid beneficiaries with T2D using claims data from January 2018 to August 2021. We also examined the changes in provider types delivering telehealth. Multivariable logistic regression was conducted to identify individual level and zip code-level factors associated with telehealth use during the COVID-19 pandemic.

Results: The monthly proportion of outpatient visits delivered by telehealth was low (< 1%) before the pandemic, spiked in April 2020 (> 15%), then remained at approximately 5%. Telehealth use varied across different racial/ethnic groups, geography and age groups over years. Older beneficiaries were less probable to use telehealth during the pandemic (adjusted odds ratio [AOR] = 0.874, 95% confidence interval [CI]: 0.831-0.919). Females used more telehealth than males (AOR = 1.359, 95% CI: 1.298-1.423). Black beneficiaries used more telehealth than White beneficiaries (AOR = 1.067, 95% CI: 1.000-1.139). More telehealth services were used by Medicaid beneficiaries who were living in urban areas, with more primary care utilization, and with more chronic conditions at baseline.

Conclusions: We found disparities in the uptake of telehealth during the COVID-19 pandemic, but they might have been narrowed for some groups (Hispanic and rural) among Louisiana Medicaid beneficiaries with T2D. Future studies should explore strategies to improve access to telehealth services and reduce related disparities for the low-income population.

Keywords: cohort study; primary care; real-world evidence; type 2 diabetes.