Am J Prev Med. 14 March 2022: S0749-3797(22)00071-X. doi: 10.1016/j.amepre.2021.12.025. Online ahead of print.
INTRODUCTION: In this study, we examined the association between the use of telemedicine before a disaster and the use of emergency or hospital departments for ambulatory care-sensitive conditions after the disaster.
METHODS: Difference-in-differences analyzes were conducted in 2020-2021 to assess pre- and post-fire changes in emergency or hospital use for 5 ambulatory care sensitive conditions: asthma, diabetes, hypertension, coronary heart disease and heart failure in all cases. Kaiser Permanente Santa Rosa patients (N=108,113) based on telemedicine use prior to the 2017 Tubbs fire. Inverse treatment weighting probability was used to balance cohorts by familiarity status with telemedicine.
RESULTS: Use for any ambulatory care sensitive condition increased from 9.03% pre-fire to 9.45% post-fire across the entire cohort. Familiarity with telemedicine (ref: not familiar) was associated with decreased absolute risk in inpatient and emergency department use before and after the fire for 4 conditions: asthma (absolute risk = – 1.59%, 95% CI = -2.02%, -1.16% ), diabetes (absolute risk = -0.68%, 95% CI = -0.89%, -0.47% ), hypertension (absolute risk = -2.07%, 95% CI = -2.44%, -1.71%) and coronary artery disease (absolute risk = -0.43%, 95% CI = -0 .61%, -0.24%). Familiarity with telemedicine was associated with a decrease in the relative change in use before and after the fire for 5 conditions: asthma (RRR = 0.70, 95% CI = 0.64, 0.75), diabetes (RRR=0.54, 95% CI=0.47, 0.63), hypertension (RRR=0.57, 95% CI=0.52, 0.62), heart failure (RRR=0 .64, 95% CI=0.50, 0.82) and coronary heart disease (RRR=0.56, 95% CI=0.47, 0.67). Similar results were seen in patients residing in evacuation zones.
CONCLUSIONS: Familiarity with telemedicine before the fire was associated with decreased use of inpatient and emergency departments for certain ambulatory care-sensitive conditions for one year after the fire. These findings suggest a role for telemedicine in preventing unnecessary emergencies and hospital utilization following disasters.