Our May Issue: Telemedicine, Disparities, Pharmaceuticals & More

The May issue of Health Affairsa variety issue, includes studies about the use of telemedicine during COVID-19, the impact of a temporary initiative on food insecurity, and ways to improve care for elderly people as part of the journal’s ongoing “Age-Friendly Health” series.

Featured articles highlighted and described below:

The 2021 Child Tax Credit expansion was linked to greater food security.

According to the Department of Agriculture, one in seven families with children experience food insecurity, a problem exacerbated during the COVID-19 pandemic. The expanded Child Tax Credit (CTC), part of the American Rescue Plan Act of 2021, provided monthly cash payments to lower-income families during the second half of 2021. To estimate relations on children’s dietary intake, Elizabeth Adams of the University of South Carolina conducted a survey of parents, assessing household food security before and after three months of CTC payments. The authors found that the percentage of families who were food secure increased from 57.4 percent to 66.4 percent, with reported decreases in children’s consumption of added sugar and sugar-sweetened beverages and fruit juices. However, the authors did not discern any other changes in children’s intake of other dietary components, such as nutrient-rich foods. The authors recommend research to better understand what types of food were purchased with the additional CTC funds each month and who in the home consumed the food.

Inequities in telemedicine use during COVID-19.

At the beginning of the COVID-19 pandemic, the Centers for Medicare and Medicaid Services, anticipating a growing need for health care, significantly expanded telemedicine coverage for all US Medicare beneficiaries. To better understand the temporal trends and examine the association of telemedicine use with the socioeconomic status of a patient, Sanuja Bose of Johns Hopkins University and coauthors reviewed Medicare fee-for-service claims data from January 2019 through March 2021. They stratified the patients by national Area Deprivation Index (ADI) and adjusted for age, sex, race, ethnicity, comorbidities, and region and residence factors. They found that before the telemedicine coverage waiver, less than 1 percent of Medicare patients had at least one outpatient telemedicine visit, with little difference by ADI. With the waiver, there was a more than twenty-fold increase in use, with the highest odds of use seen for people living in the most disadvantaged neighborhoods. Although several studies to date have highlighted concerns that increased telemedicine coverage is worsening preexisting disparities among certain populations during the COVID-19 pandemic, the authors suggest that their data show that among the Medicare population this problem may not have worsened in the way some investigators feared. .

AGE-FRIENDLY HEALTH: End-of-life care in US assisted living communities.

During the past three decades, assisted living communities have become an increasingly common choice for many older Americans, serving mostly frail residents with cognitive and functional impairments. Few studies to date have examined end-of-life care among this population, and little is known about how racial, ethnic, and socioeconomic differences may affect end-of-life care. In one of the first studies to fill in some of these gaps, Helena Temkin-Greener at the University of Rochester and coauthors evaluated government data for Medicare fee-for-service, including dual Medicare-Medicaid enrollees, residing in assisted living communities who died in 2018–19. The authors found that 59.7 percent of the Medicare beneficiaries died at home, 23.7 percent died in nursing homes, and 16.6 percent died in hospitals or emergency departments. Dual enrollees were less likely to die at home (36.9 percent), more than twice as likely to die in a nursing home (44.0 percent), and slightly more likely to die in a hospital or emergency department (19.1 percent.) Of those Medicare enrollees who died at home, 84 percent had home hospice. Black residents, regardless of insurance enrollment, were significantly less likely than White or Hispanic residents to have been enrolled in hospice care at death. The study is also the first to show a relationship between state regulatory stringency and care quality in assisted living. The authors conclude that their findings may help inform efforts focused on ensuring equitable end-of-life care planning and services in assisted living communities.

Also of interest in the May issue:

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