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Chang MH, Moonesinghe R, Truman BI. Health Care Use among Medicare Beneficiaries with HIV and Depression during the COVID-19 Pandemic-United States, 2020. Healthcare (Basel) 2023; 11:healthcare11081126. [PMID: 37107960 PMCID: PMC10137947 DOI: 10.3390/healthcare11081126] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/15/2023] [Revised: 04/06/2023] [Accepted: 04/11/2023] [Indexed: 04/29/2023] Open
Abstract
Access and use of health care services are essential to health and well-being for people with HIV and HIV-related comorbidities. Health care use during the COVID-19 pandemic among Medicare beneficiaries (MBs) with concurrent HIV and depression has not been investigated. We used 2020 Medicare data to assess the percentage of MBs with claims for HIV and depression who also received hospitalization, outpatient diagnostic services, drug treatment, and outpatient procedures. We assessed person-level association between service receipt and HIV and depression, adjusting for known risk factors. MBs with claims for HIV and depression were more likely than those with neither claim to have claims for short-stay hospitalization, long-stay hospitalization, outpatient diagnostic services, prescription drugs, or outpatient procedures, supplies, and products. Non-White beneficiaries were more likely than White beneficiaries to be hospitalized but were less likely to receive drug treatment, outpatient diagnostic services, or outpatient procedures, supplies, and products during the pandemic. Significant disparities in health care use by race/ethnicity existed among MBs. Policymakers and practitioners can use these findings to implement public health policies and programs that reduce disparities in health care access and optimize use among vulnerable populations during a public health emergency.
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Affiliation(s)
- Man-Huei Chang
- National Center for HIV, Viral Hepatitis, STD, and TB Prevention, Centers for Disease Control and Prevention, Atlanta, GA 30329, USA
| | - Ramal Moonesinghe
- Office of Genomics and Precision Public Health, Centers for Disease Control and Prevention, Atlanta, GA 30345, USA
| | - Benedict I Truman
- National Center for HIV, Viral Hepatitis, STD, and TB Prevention, Centers for Disease Control and Prevention, Atlanta, GA 30329, USA
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Venegas-Murillo AL, Bazargan M, Grace S, Cobb S, Vargas R, Givens S, Li-Sarain S, Delgado C, Villatoro J, Goodall A, Tesimale R, Ramirez S, Brown M, Uyanne J, Assari S. Mitigating COVID-19 Risk and Vaccine Hesitancy Among Underserved African American and Latinx Individuals with Mental Illness Through Mental Health Therapist-Facilitated Discussions. J Racial Ethn Health Disparities 2022; 10:1358-1370. [PMID: 35534682 PMCID: PMC9083473 DOI: 10.1007/s40615-022-01321-7] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/10/2022] [Revised: 04/18/2022] [Accepted: 04/28/2022] [Indexed: 11/25/2022]
Abstract
Background Underserved ethnic minorities with psychiatric disorders are at an increased risk of COVID-19. This study aims to examine the effectiveness of one-to-one counseling on COVID-19 vaccination and vaccination readiness among underserved African American and Latinx individuals with mental illnesses and adult caregivers of children with mental illness. Methods Through an academic-community partnered collaboration, a multidisciplinary and culturally sensitive training on COVID-19 was co-developed and delivered to 68 therapists from January to March 2021. Mental health clients and their caregivers were recruited to participate in pre- and post-intervention surveys to evaluate the impact of the intervention on their perceptions of COVID-19 public health guidelines, testing, and vaccination. Mental health therapists delivered four lessons of the COVID-19 educational intervention with 254 clients from March to June 2021, when vaccine availability was widely available. Of those clients, we collected 180 baseline and 115 follow-up surveys. The main outcome was the uptake in COVID-19 vaccine. Results There was a positive shift in participant vaccine acceptance and receptivity. Pre-intervention survey shows that only 56% of adult clients and 48% of caregivers had indicated a likelihood of getting the vaccine for themselves at baseline. Post-intervention documented that more than 57% of each group had been vaccinated, with another 11–15% of the unvaccinated individuals reporting that they were somewhat or very likely to get the vaccine. Conclusion This study demonstrated that multidisciplinary academic-community and theoretical-based educational intervention delivered by mental health therapists is an effective strategy in increasing COVID-19 vaccine acceptance and reducing the negative impact and disruption that COVID-19 caused in the daily life of mental health patients and caregivers.
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Affiliation(s)
| | - Mohsen Bazargan
- Charles R. Drew University of Medicine and Science (CDU), Los Angeles, CA USA
- Department of Family Medicine, UCLA, Los Angeles, CA USA
| | - Stephen Grace
- Tessie Cleveland Community Services Corporation (TCCSC), Los Angeles, CA USA
| | - Sharon Cobb
- Charles R. Drew University of Medicine and Science (CDU), Los Angeles, CA USA
| | - Roberto Vargas
- Charles R. Drew University of Medicine and Science (CDU), Los Angeles, CA USA
| | - Shronda Givens
- Tessie Cleveland Community Services Corporation (TCCSC), Los Angeles, CA USA
| | - Sheila Li-Sarain
- Tessie Cleveland Community Services Corporation (TCCSC), Los Angeles, CA USA
| | - Carissa Delgado
- Tessie Cleveland Community Services Corporation (TCCSC), Los Angeles, CA USA
| | - Jeffry Villatoro
- Tessie Cleveland Community Services Corporation (TCCSC), Los Angeles, CA USA
| | - Asia Goodall
- Tessie Cleveland Community Services Corporation (TCCSC), Los Angeles, CA USA
| | - Rylan Tesimale
- Tessie Cleveland Community Services Corporation (TCCSC), Los Angeles, CA USA
| | - Sylvia Ramirez
- Tessie Cleveland Community Services Corporation (TCCSC), Los Angeles, CA USA
| | - Monica Brown
- Tessie Cleveland Community Services Corporation (TCCSC), Los Angeles, CA USA
| | - John Uyanne
- Charles R. Drew University of Medicine and Science (CDU), Los Angeles, CA USA
| | - Shervin Assari
- Charles R. Drew University of Medicine and Science (CDU), Los Angeles, CA USA
- Tessie Cleveland Community Services Corporation (TCCSC), Los Angeles, CA USA
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Handley SC, Ledyard R, Lundsberg LS, Passarella M, Yang N, Son M, McKenney K, Greenspan J, Dysart K, Culhane JF, Burris HH. Changes in prenatal testing during the COVID-19 pandemic. Front Pediatr 2022; 10:1064039. [PMID: 36440341 PMCID: PMC9682111 DOI: 10.3389/fped.2022.1064039] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/07/2022] [Accepted: 10/24/2022] [Indexed: 11/10/2022] Open
Abstract
OBJECTIVE The coronavirus disease 2019 (COVID-19) pandemic disrupted healthcare delivery, including prenatal care. The study objective was to assess if timing of routine prenatal testing changed during the COVID-19 pandemic. METHODS Retrospective observational cohort study using claims data from a regional insurer (Highmark) and electronic health record data from two academic health systems (Penn Medicine and Yale New Haven) to compare prenatal testing timing in the pre-pandemic (03/10/2018-12/31/2018 and 03/10/2019-12/31/2019) and early COVID-19 pandemic (03/10/2020-12/31/2020) periods. Primary outcomes were second trimester fetal anatomy ultrasounds and gestational diabetes (GDM) testing. A secondary analysis examined first trimester ultrasounds. RESULTS The three datasets included 31,474 pregnant patients. Mean gestational age for second trimester anatomy ultrasounds increased from the pre-pandemic to COVID-19 period (Highmark 19.4 vs. 19.6 weeks; Penn: 20.1 vs. 20.4 weeks; Yale: 18.8 vs. 19.2 weeks, all p < 0.001). There was a detectable decrease in the proportion of patients who completed the anatomy survey <20 weeks' gestation across datasets, which did not persist at <23 weeks' gestation. There were no consistent changes in timing of GDM screening. There were significant reductions in the proportion of patients with first trimester ultrasounds in the academic institutions (Penn: 57.7% vs. 40.6% and Yale: 78.7% vs. 65.5%, both p < 0.001) but not Highmark. Findings were similar with multivariable adjustment. CONCLUSION While some prenatal testing happened later in pregnancy during the pandemic, pregnant patients continued to receive appropriately timed testing. Despite disruptions in care delivery, prenatal screening remained a priority for patients and providers during the COVID-19 pandemic.
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Affiliation(s)
- Sara C Handley
- Divison of Neonatology, Children's Hospital of Philadelphia, Philadelphia, PA, United States.,Department of Pediatrics, Perelman School of Medicine at the University of Pennsylvania, Philadelphia, PA, United States.,Leonard Davis Institute of Health Economics, Philadelphia, PA, United States
| | - Rachel Ledyard
- Divison of Neonatology, Children's Hospital of Philadelphia, Philadelphia, PA, United States
| | - Lisbet S Lundsberg
- Department of Obstetrics, Gynecology, and Reproductive Services, Yale School of Medicine, New Haven, CT, United States
| | - Molly Passarella
- Divison of Neonatology, Children's Hospital of Philadelphia, Philadelphia, PA, United States
| | - Nancy Yang
- Divison of Neonatology, Children's Hospital of Philadelphia, Philadelphia, PA, United States
| | - Moeun Son
- Department of Obstetrics, Gynecology, and Reproductive Services, Yale School of Medicine, New Haven, CT, United States
| | - Kathryn McKenney
- Department of Obstetrics & Gynecology, University of Colorado, Aurora, CO, United States
| | - Jay Greenspan
- Division of Neonatology, Nemours duPont Pediatrics, Philadelphia, PA, United States.,Sidney Kimmel Medical College, Thomas Jefferson University, Philadelphia, PA, United States
| | - Kevin Dysart
- Division of Neonatology, Nemours duPont Pediatrics, Philadelphia, PA, United States.,Sidney Kimmel Medical College, Thomas Jefferson University, Philadelphia, PA, United States
| | - Jennifer F Culhane
- Department of Obstetrics & Gynecology, University of Colorado, Aurora, CO, United States
| | - Heather H Burris
- Divison of Neonatology, Children's Hospital of Philadelphia, Philadelphia, PA, United States.,Department of Pediatrics, Perelman School of Medicine at the University of Pennsylvania, Philadelphia, PA, United States.,Leonard Davis Institute of Health Economics, Philadelphia, PA, United States
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A Predictive Model for Severe COVID-19 in the Medicare Population: A Tool for Prioritizing Primary and Booster COVID-19 Vaccination. BIOLOGY 2021; 10:biology10111185. [PMID: 34827181 PMCID: PMC8614832 DOI: 10.3390/biology10111185] [Citation(s) in RCA: 6] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 10/07/2021] [Revised: 10/29/2021] [Accepted: 11/04/2021] [Indexed: 01/09/2023]
Abstract
Simple Summary Whether it is for COVID-19 primary vaccination or the administration of booster vaccines, prioritization criteria need to be established to optimize COVID-19 vaccination programs accounting for both clinical and social vulnerability risks for severe COVID-19 disease. We developed a dual socio-clinical risk model for severe COVID-19 disease in the Medicare population, which is comprised mostly of individuals aged 65 and over. Our model generated risk levels correlated with regionalized COVID-19 case hospitalization rates and mapped them at the county and zip code levels. The model and map can be used by health jurisdictions to reach out to unvaccinated individuals. Our model approach can also be applied to identify Medicare beneficiaries who were in early vaccination groups to be vaccinated to identify those who might maximally benefit from an additional dose of COVID-19 vaccine if and when vaccine immunity wanes. Abstract Recommendations for prioritizing COVID-19 vaccination have focused on the elderly at higher risk for severe disease. Existing models for identifying higher-risk individuals lack the needed integration of socio-demographic and clinical risk factors. Using multivariate logistic regression and random forest modeling, we developed a predictive model of severe COVID-19 using clinical data from Medicare claims for 16 million Medicare beneficiaries and socio-economic data from the CDC Social Vulnerability Index. Predicted individual probabilities of COVID-19 hospitalization were then calculated for population risk stratification and vaccine prioritization and mapping. The leading COVID-19 hospitalization risk factors were non-white ethnicity, end-stage renal disease, advanced age, prior hospitalization, leukemia, morbid obesity, chronic kidney disease, lung cancer, chronic liver disease, pulmonary fibrosis or pulmonary hypertension, and chemotherapy. However, previously reported risk factors such as chronic obstructive pulmonary disease and diabetes conferred modest hospitalization risk. Among all social vulnerability factors, residence in a low-income zip code was the only risk factor independently predicting hospitalization. This multifactor risk model and its population risk dashboard can be used to optimize COVID-19 vaccine allocation in the higher-risk Medicare population.
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