EFFECTS OF COVID-19 ON DIABETES AND HYPERTENSION MONITORING AND CONTROL IN PRIMARY CARE

ABSTRACT

BACKGROUND: Drops in chronic disease performance metric occurred during the COVID-19 pandemic in 2020. We evaluated changes in diabetes and hypertension disease control and disease non-assessment during the year prior and the initial year of COVID in a large group of Chicago-area primary care practices and evaluated factors associated with non-assessment. METHODS: Design: Retrospective observational studies of two cohorts, one with diabetes mellitus, and one with hypertension. Participants: Patients in the denominator for the medical group's performance measures for diabetes control or hypertension control on March 31, 2020 who also had continued contact with the health system (telephone, visit, medication refill, patient portal message) between April 1, 2020 and March 31, 2021. Main Measures: Diabetes not poorly controlled (HbA1C done in the past year and ≤9.0), diabetes cohort;Controlling High Blood Pressure (office blood pressure measured in the past 12 months and the most recent blood pressure was <140/90mmHg), hypertension cohort. Weexamined rates of poor control due to uncontrolled disease or lack of assessment. For patients with measurements in both the year preceding and the year following March 31, 2020, we calculated changes in HbA1C and weight (diabetes cohort) and systolic blood pressure and weight (hypertension cohort). RESULTS: In the diabetes cohort of 16,015, control was 78.0% in the year prior to March 31, 2020 and fell to 69.4% the following year. For the 57,346 patients in the hypertension cohort, the corresponding rates were 64.0% and 52.1%. For diabetes, 10.5% of the cohort had no HbA1C in the pre-COVID year and 22.0% had no HbA1C in the subsequent year. For hypertension, rates of non-assessment were 6.3% and 22.9%, respectively. Significant predictors of non-assessment in the first COVID year for diabetes and hypertension included younger age (18-49 year old, ORs 1.42, 1.11), having ≥ 1 telehealth visit (ORs 2.29, 7.82), and having ≥ 1 office visit (ORs 0.02, 0.005). Among diabetes patients who had HbA1C and weight measurements in both years, both declined?mean difference for HbA1C was -0.08 (95%CI -0.05 to -0.10) and weight -0.77 kg (CI -0.34 to -0.88). Among hypertension patients with blood pressure and weight measurements in both years, mean difference systolic blood pressure increased by 0.77 mmHg (CI 0.60 to 0.94) and weight decreased -0.30 kg (CI -0.25 to -0.35). CONCLUSIONS: During the first year of the COVID, many more patients with diabetes and hypertension did not have basic assessments of their disease control compared to the prior year, and type of visits (telehealth and office) was strongly associated with non-assessment. Among diabetes patients who were assessed there was no evidence of worsening disease HbA1C or weight. Systolic blood pressure increased slightly among hypertensive patients.