Outpatient Care for COVID-19

A pandemic inherently changes the way we approach care—from healthcare to defining what “health” ultimately means. From hesitancy to influxes of sick patients, but also those now dealing with the chronic aspects of COVID-19 infections, we’ve had to recalibrate what healthcare looks like during and following a pandemic.

The pandemic and risk of infection has changed healthcare in terms of rates of healthcare-associated infections to even declining vaccination rates.^1,2 Increasingly, we’re trying to understand what the pandemic, but also infection, has meant for accessing care, such as outpatient healthcare.

In this vein, a new study published in JAMA sought to better understand the association of COVID-19 infection with outpatient care utilization.³ Researchers drew on the critical need for comparison studies between care usage rather than surveillance studies. By utilizing a retrospective cohort study of Veteran Affairs patients, they matched those with COVID-19 infection to those without infection, from January 2019 through December 2022. Pre-infection and post-infection periods were monitored, dividing the later into three periods – 0 to 30-day peri-infection, a 31-182-day intermediate post-infection, and a 183-365-day long-term post-infection period. Negative binomial regression models were used to compare the usage of outpatient care over a 1-year pre-infection period and the three post-infection periods.

The researchers were able to assess 202,803 veterans (aged roughly around 60.5 years and 88.1% being male) with COVID-19 infections and 202,803 uninfected veterans (60.4 years of age, and 88.1% male). Other than surgical care, outpatient use was elevated during the peri-infection period for those with COVID-19 infection when compared to the uninfected cohort.

The authors noted “an increase in all visits of 5.12 visits per 30 days (95% CI, 5.09-5.16 visits per 30 days), predominantly owing to primary care visits (increase of 1.86 visits per 30 days; 95% CI, 1.85-1.87 visits per 30 days). Differences in outpatient use attenuated over time but remained statistically significantly higher at 184 to 365 days after infection (increase of 0.25 visit per 30 days; 95% CI, 0.23-0.27 visit per 30 days). One-half of the increased outpatient visits were delivered via telehealth. The utilization increase was greatest for veterans aged 85 years and older (6.1 visits, 95% CI, 5.9-6.3 visits) vs those aged 20 to 44 years (4.8 visits, 95% CI, 4.7-4.8 visits) and unvaccinated veterans (4.5 visits, 95% CI, 4.3-4.6 visits) vs vaccinated veterans (3.2 visits; 95% CI, 3.4-4.8 visits).”

This study underscores the importance of monitoring post-infection and ultimately, post-pandemic trends in patient care and long-term COVID-19 infection needs. Work to ensure access to care and outreach regarding the importance of seeking care post-COVID-19 infection will be critical as we move into this non-acute phase of the pandemic.

While the acute crisis of the pandemic may be over, navigating this new phase will be challenging and require significant analysis and response to ensure we don’t make the mistake of past, but also ensure health is more widely present.

References

1. COVID-19 Impact on HAIs. CDC. June 10, 2022. Accessed March 12, 2024. https://www.cdc.gov/hai/data/portal/covid-impact-hai.html

2. COVID-19 pandemic fuels largest continued backslide in vaccinations in three decades. World Health Organization. July 15, 2022. https://www.who.int/news/item/15-07-2022-covid-19-pandemic-fuels-largest-continued-backslide-in-vaccinations-in-three-decades

3. Hebert PL, Kumbier KE, Smith VA, et al. Changes in Outpatient Health Care Use After COVID-19 Infection Among Veterans. JAMA Netw Open. 2024;7(2):e2355387. doi:10.1001/jamanetworkopen.2023.55387