Abstract
Background
Sickle cell disease (SCD), a rare inherited blood disorder, causes significant morbidity and early mortality. Telehealth, which has increased during the COVID-19 pandemic, can improve access to care for individuals with chronic conditions.Objective
Our objectives were (1) characterize telehealth use among individuals with SCD during the COVID-19 pandemic and (2) assess differences in demographics and healthcare utilization between those who did and did not use telehealth.Methods
The Sickle Cell Data Collection Program is a CDC-funded multi-source data collection initiative to study long term trends in outcomes and healthcare among individuals with SCD. Medicaid claims from September 2019-December 2020 were collected for individuals with SCD in four program states: Michigan, Georgia, Tennessee, and California. Telehealth encounters were identified during the pandemic (March 2020-December 2020) and characterized by provider specialty and presence of an SCD diagnosis code. Healthcare utilization (emergency department encounters, outpatient encounters, inpatient admissions) was compared between those who did (users) and did not (non-users) use telehealth, stratified by before and during the pandemic. Individuals ≥1 year old with SCD, identified using validated case definitions, who were continuously enrolled in a Medicaid program in MI, GA, TN or CA from September 2019-December 2020.Results
A total of 8,681 individuals with SCD (1,880 MI, 3,612 GA, 1,551 TN and 1,638 CA) were included; 50% under 18 years old, 57% female. The proportion of individuals with SCD that accessed telehealth at least once during the pandemic varied across states from 29% in TN to 80% in CA. All states saw a sharp increase in monthly telehealth use among individuals with SCD during the first two months of the pandemic. During the pandemic, a total of 21,632 telehealth encounters across 3,647 users were identified; 54% included a SCD-related diagnosis (28% MI, 29% GA, 45% TN and 72% CA). In two states (MI and GA), over a third of telehealth encounters were with behavioral health providers, while in CA, telehealth visits were split between hematologists and other non-primary care specialists. Telehealth users had an average of 5 (min=1, max=229) telehealth encounters during the pandemic. Telehealth users had higher average number of healthcare encounters during the pandemic: emergency department (pooled mean=2.6 for users vs 1.5 for non-users), inpatient (1.2 for users vs 0.6 for non-users) and outpatient encounters (6.0 for users vs 3.3 for non-users). Pre-pandemic utilization was also slightly higher among people who accessed telehealth during the pandemic as compared to those that did not.Conclusion
Telehealth use among individuals with SCD peaked in the early pandemic and settled into levels that remained higher than pre-pandemic. Individuals who accessed care through telehealth had higher acute care utilization than non-users during the pandemic. Telehealth encounters with behavioral health providers were common for several states. Telehealth appears to be a feasible way for the SCD population to access care, particularly related to behavioral health. Further research is necessary to understand the acceptability of specific types of SCD-related care to be provided by telehealth.Categories: Conference Abstracts/Posters