Blood pressure control in veterans declined during the COVID-19 pandemic
Researchers identified a 7% decline in blood pressure control during the pandemic
A multi-institution team led by researchers at the White River Junction VA Medical Center in Vermont found that Veterans’ blood pressure control worsened due to disrupted care during the COVID-19 pandemic. The findings were published in the journal Medical Care.
The researchers followed a group of nearly 1.65 million Veterans who received their care at VA and who had high blood pressure (hypertension) during two periods—before the pandemic and during the pandemic. In Veterans with controlled blood pressure, researchers found a 7% decline in control during the pandemic compared to before the pandemic. Longer follow-up intervals were associated with a decreased likelihood of maintaining blood pressure control in both periods.
Most of the difference in control was explained by delays in follow-up care, according to the research team, led by Dr. Caroline Korves. But the pandemic itself was responsible for a small (2%) effect on blood pressure control.
Researchers also discovered that Veterans who had not yet achieved blood pressure control and who experienced longer intervals between follow-up care were modestly more likely to gain control during the pandemic, but not before the pandemic. The finding suggests that providers focused slightly more on people with uncontrolled blood pressure, an appropriate clinical response, according to the team.
“Opportunities for further research into the cause of the pandemic effect—whether lower maintenance of control stemmed from missed opportunity for treatment modifications, changes in patient behavior, or other factors―and investigating whether a modestly higher likelihood of gaining control was due to focusing on patients with more extreme conditions, would offer valuable insights in how to prevent disruptions in care during similar crises,” wrote the researchers.
High blood pressure remains one of the top public health challenges in the country and contributes to serious health problems, like heart disease and kidney failure. It is a modifiable risk factor for heart disease―meaning it can respond to treatment―and is an important marker to track for disruptions in care, according to the research team.
The research was part of the VA Health Services Research and Development Disrupted Care National Project (DCNP), that aims to better understand disruptions in care during the COVID-19 pandemic. The DCNP is led by Dr. Louise Davies, Dr. Amy Justice, and Dr. Anita Vashi, and is based at the White River Junction VA Medical Center, Vermont, with additional sites at West Haven, Connecticut, and Palo Alto, California.
JOURNAL
Medical Care
METHOD OF RESEARCH
Data/statistical analysis
SUBJECT OF RESEARCH
People
ARTICLE TITLE
Hypertension Control During the Coronavirus Disease 2019 Pandemic: A Cohort Study Among US Veterans
ARTICLE PUBLICATION DATE
6-Mar-2024
COI STATEMENT
C.K. has been an investigator on projects with research grants from Pfizer and Sanofi Pasteur for work unrelated to this manuscript. A.J.P. is or has been the principal investigator on research grants from Bayer, Boehringer-Ingelheim, Lundbeck, Reata, and Vascular Dynamics to Yale University for work unrelated to this manuscript; has received honoraria for data safety monitoring activities from Ablative Solutions and KBP Biosciences; and has received consulting fees from BD, CinCor, and Diamedica, all for work unrelated to this manuscript. D.M.W. has received consulting fees for work unrelated to this manuscript from Pfizer, Merck, GSK, Affinivax, and Matrivax, and is the Principal Investigator on research grants from Pfizer and Merck to Yale University for work unrelated to this manuscript. The remaining authors declare no conflict of interest.
Continuous Medicaid eligibility during the pandemic and postpartum coverage, health care, and outcomes
JAMA Health Forum
Peer-Reviewed PublicationAbout The Study: In this study including 47,000 participants, continuous Medicaid eligibility during the COVID-19 pandemic significantly reduced loss of Medicaid after birth, suggesting similar uninsurance reductions may be expected from post-pandemic postpartum Medicaid extensions, which most states plan to implement.
Authors: Jamie R. Daw, Ph.D., of the Columbia University Mailman School of Public Health in New York, is the corresponding author.
To access the embargoed study: Visit our For The Media website at this link https://media.jamanetwork.com/
(doi:10.1001/jamahealthforum.2024.0004)
Editor’s Note: Please see the article for additional information, including other authors, author contributions and affiliations, conflict of interest and financial disclosures, and funding and support.
# # #
Embed this link to provide your readers free access to the full-text article
About JAMA Health Forum: JAMA Health Forum is an international, peer-reviewed, online, open access journal that addresses health policy and strategies affecting medicine, health and health care. The journal publishes original research, evidence-based reports and opinion about national and global health policy; innovative approaches to health care delivery; and health care economics, access, quality, safety, equity and reform. Its distribution will be solely digital and all content will be freely available for anyone to read.
JOURNAL
JAMA Health Forum
Medicaid eligibility during pandemic led to increased postpartum coverage, study suggests
Historically, Medicaid coverage ended at 60 days postpartum, but experts highlight the risk of maternal deaths between 43 and 365 days postpartum
Peer-Reviewed PublicationMaternal mortality rates in the U.S. are increasing and considered high compared to other wealthy nations. And Medicaid coverage plays a large role in maternal health, as it funds nearly half of all the births in the country.
Medicaid coverage has historically ended at 60 days postpartum, but according to new data, a significant number of maternal deaths are happening between 43 and 365 days postpartum.
“In the U.S., health insurance is really a necessary prerequisite to get high quality care,” said senior author Lindsay Admon, M.D., M.Sc., an assistant professor of obstetrics and gynecology at the University of Michigan Medical School and obstetrician-gynecologist at U-M Health Von Voigtlander Women’s Hospital.
“It’s not the only step, but it’s a critical first step because without it, it’s hard to get a foot in the door.”
COVID-19 and coverage
Under the Families First Coronavirus Response Act (FFCRA) in March 2020, Admon notes, Medicaid programs were not allowed to disenroll people from Medicaid during the public health emergency. This was the first time pregnancy related Medicaid coverage was extended past 60 days postpartum. The American Rescue Plan Act (ARPA) then passed in 2021, which provides states with federal funding to extend Medicaid coverage through the first year postpartum now that the pandemic has ended.
Admon and her fellow collaborators analyzed data to study the impact of the FFCRA on postpartum coverage and care during the pandemic. For people who had Medicaid at the time that they gave birth, they found that the policy allowed for large increases in postpartum Medicaid enrollment and a 40% decline in postpartum uninsurance, according to their study in JAMA Health Forum.
“As of March 2024, almost all states either have implemented or plan to implement extensions of pregnancy Medicaid coverage through the first year postpartum,” said lead author Jamie Daw, Ph.D., an assistant professor of health policy and management at the Columbia University Mailman School of Public Health.
“The results from our study are very encouraging, suggesting that those extensions are likely to significantly increase continued Medicaid enrollment and decrease uninsurance during the postpartum year.”
Postpartum coverage crucial
Nearly half of U.S. births are covered by Medicaid. Yet, once an individual gives birth, it can be more difficult to remain covered by Medicaid, Admon says, leaving postpartum people in a potentially dangerous position.
“A lot of postpartum maternal deaths are occurring in the late postpartum period, or beyond 43 days postpartum, which is actually around the time Medicaid coverage has historically ended.” Admon said.
“We know some of the leading causes of maternal deaths from the late postpartum period are things like behavioral health conditions, and it is difficult to remain in treatment without insurance coverage.”
While this study found that postpartum Medicaid enrollment increased while recipients were not allowed to be disenrolled, the authors found no association with postpartum visit attendance, contraception use, breastfeeding or depressive symptoms.
Coverage extensions beneficial
However, Daw says the COVID-19 pandemic could have played a factor in the lack of these findings due to stay at home orders that were in effect across the country and the fact that data used in the study only followed people for a few months postpartum, not the entire postpartum year.
“States can learn from this national experiment during the pandemic and apply these findings to consider the potential impact of adopting an ongoing extension of pregnancy related Medicaid coverage through the first year postpartum,” Admon said.
JOURNAL
JAMA Health Forum
ARTICLE TITLE
Continuous Medicaid Eligibility During the COVID-19 Pandemic and Postpartum Coverage, Health Care, and Outcomes
ARTICLE PUBLICATION DATE
8-Mar-2024
No comments:
Post a Comment