News Scan for Dec 29, 2020

News brief

Age, race, income linked to rates of telehealth visits in COVID pandemic

Older people, Asians, and those with Medicaid coverage and preference for a non-English language at one US hospital system had fewer completed telemedicine visits than their peers during the COVID-19 pandemic, according to a study of patients scheduled for primary care or specialty telehealth visits at the University of Pennsylvania.

The retrospective cohort electronic medical records study, published today in JAMA Network Open, also found that older people, women, blacks, Latinos, and those with lower household incomes were less likely than other patients to use video for telehealth visits. The results were comparable across all medical specialties.

Of the 148,402 patients with telemedicine appointments from Mar 16 to May 11, 80,780 (54.4%) completed their visits. Among the 78,539 patients in which video or phone modality were recorded, 35,824 (45.6%) were video visits, and 42,715 (54.4%) took place over the phone.

In multivariable analyses, older age was independently linked to fewer completed telehealth appointments (adjusted odds ratio [aOR], 0.85 for those 55 to 64 years; aOR, 0.75 for those 65 to 74; and aOR, 0.67 for those 75 and older). Other factors tied to fewer completed remote visits were Asian race (aOR, 0.69), preference for a language other than English (aOR, 0.84), and Medicaid insurance coverage (aOR, 0.93).

Similarly, older age was associated with less use of video for telehealth appointments (aOR, 0.79 for patients 55 to 64 years; aOR, 0.78 for those 65 to 74; aOR, 0.49 for those 75 and older). Women (aOR, 0.92), blacks (aOR, 0.65), Latinos (aOR, 0.90), and those with lower incomes (aOR, 0.57 for those with annual household incomes less than $50,000; aOR, 0.89 for those with incomes of $50,000 to $100,000) were less likely to use video for their remote visits.

"This study identified racial/ethnic, sex, age, language, and socioeconomic differences in accessing telemedicine for primary care and specialty ambulatory care; if not addressed, these differences may compound existing inequities in care among vulnerable populations," the authors wrote.

They also called for the guarantee of payer coverage of all telemedicine visits after the pandemic through legislative action. "Lower reimbursement for telephone visits may disproportionately and unjustly hurt clinics and clinicians that care for patients in minority groups and patients with lower income," they said.
Dec 29 JAMA Netw Open study


Study finds $736 million economic burden for Arizona valley fever

A study yesterday in Open Forum Infectious Diseases details clinical and economic costs associated with valley fever (coccidioidomycosis), a fungal infection endemic to the Southwest caused by inhaling soil spores.

The incidence of valley fever has increased in recent years, with illness that ranges from flulike symptoms to pneumonia, meningitis, and death. For some patients, symptoms become chronic, and the lung infection spreads to other parts of the body, requiring lifetime antifungal treatment and recurrent hospitalization. Delays in diagnosis are common, even in areas where valley fever is endemic.

Researchers estimated cost of illness for 10,359 cases of valley fever diagnosed in 2019 in Arizona—the location of two-thirds of all national cases—and 7,466 cases in California. They detailed both direct, healthcare system costs for treatment and indirect costs resulting from absenteeism and earnings lost due to premature death.

The researchers found that valley fever was responsible for an estimated $736 million in total lifetime costs for all cases diagnosed in Arizona in 2019, with 91% of expenditures classified as direct costs ($671 million) and $65 million in indirect costs. The average lifetime direct costs for Arizona residents with valley fever was estimated at $64,800 per person.

Arizona patients with primary uncomplicated pneumonia had the lowest cost of illness ($23,200 direct and $1,300 indirect costs per person), while individuals with disseminated infection had the highest economic burden ($1.26 million direct and $137,400 indirect costs per person).

Total lifetime costs for valley fever in California were estimated at $700 million, with $429 million in direct costs, a per-person average of $57,000.

The researchers highlighted additional costs associated with delayed diagnosis and the lack of commercial interest in developing more sensitive, rapid diagnostic tests, therapies, or vaccines.

"Understanding the economic burden that valley fever places on Arizona will help illuminate the need to direct more resources to solving this costly problem, through efforts such as prevention, accurate diagnosis, access to care, and vaccine and antifungal drug development," the authors wrote.
Dec 28 Open Forum Infect Dis study


H5N8 avian flu outbreaks hit more poultry in 3 countries

Three countries—Germany, Japan, and the United Kingdom—reported more highly pathogenic H5N8 avian influenza outbreaks in poultry, according to government statements and notifications from the World Organization for Animal Health (OIE).

Germany reported an outbreak at a goose farm in Schleswig-Holstein state that began on Dec 27, killing 44 of 1,890 birds. Elsewhere in Europe, the UK's Department for Environment, Food, and Rural Affairs (DEFRA) reported that an H5N8 outbreak at a duck farm in Norfolk was confirmed yesterday. It also noted that highly pathogenic H5N8 was confirmed in nonpoultry captive birds at a different location in Norfolk.

Japan, which has been experiencing H5N8 outbreaks involving a strain distinct from the one currently circulating in Europe but similar to one infecting birds in South Korea, reported 17 more outbreaks in poultry. The outbreaks began between Dec 9 and Dec 23, mainly affecting layer and broiler chickens. The virus struck farms in eight different provinces, with Miyazaki the hardest hit. Taken together, the virus killed 578 of 2,228,000 birds, and the rest were slated for culling.
Dec 28 OIE report on H5N8 in Germany
Dec 29 DEFRA update
Dec 28 OIE report on 8 H5N8 outbreaks in Japan
Dec 28 OIE report on 9 H5N8 outbreaks in Japan

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