Health Care Utilization in the Months After COVID-19 Infection

In the months after COVID-19 infection, some patients may experience post-acute sequelae of COVID-19 (PASC), commonly referred to as “long COVID.” The continuation of COVID-19 symptoms inevitably leads patients to continue seeking health care after acute infection.

The impact of post-COVID conditions (PCC) on health care uptake has not been extensively described. A recent study, published in JAMA, examined whether COVID-19 infection is associated with health care utilization 6 months after acute illness.

The investigators sought to estimate the excess COVID-19-related health care usage, as well as the most troublesome long COVID symptoms pushing patients to seek medical help.

The matched, retrospective, cohort study included patients from 8 large integrated health systems from across the United States. Patients of all ages completed a COVID-19 diagnostic test between March 1-November 1, 2020.

The final study included 127859 patients with a positive COVID-19 test; they were matched by age, sex, race, ethnicity, and date of COVID-19 test to 127859 patients who tested negative for COVID-19. Data were analyzed from March 18, 2021-June 8, 2022.

The average age of the cohort was 41.2 years, 53.7% were female, 51.8% were Hispanic, 7.1% were non-Hispanic Asian, 6.2% were non-Hispanic Black, and 26.9% were non-Hispanic White.

Using Poisson regression models and difference-in-difference analysis, the investigators calculated ratios of rate ratios (RRRs) for COVID-19-associated health care utilization. Overall RRRs were estimated, and estimates were then broken down by health care setting, select population characteristics, and by 44 post-COVID conditions. Excess COVID-19-associated health care utilization was estimated by health care setting.

The investigators found that health care utilization was higher in the patients who had contracted COVID-19 6 months prior. Overall, COVID-19 infection was associated with a 4% increase in health care utilization over 6 months. Health care visits were predominantly virtual.

COVID-19–associated utilization for 18 post-COVID conditions remained elevated even 6 months after acute illness, with the largest increase observed for infectious disease sequelae (86%), COVID-19 (19.47%), alopecia (2.52%), bronchitis (1.85%), pulmonary embolism or deep vein thrombosis (1.74%), and dyspnea (1.73%).

COVID-19-associated excess health care utilization accounted for an estimated 27217 additional medical encounters over 6 months.

The study authors concluded their findings suggest health systems should plan for long-term strategic resource allocation to adequately respond to the elevated health care needs of long COVID patients.