ANN ARBOR, MI — As COVID-19 burst upon the world stage, medical care rapidly shifted from in-person visits to telemedicine consultations with varying results among patients with chronic conditions, cancer and other diseases that required regular and ongoing interaction with medical personnel. Previous studies determined that veterans with lower incomes, rural residence, more severe disabilities and more comorbidities were more likely to use virtual care during the pandemic. Overall, telemedicine appointments increased more than 1,000% in the first three months of the pandemic.
Researchers at the VA Ann Arbor, MI, Healthcare System in Ann Arbor, Mich., and colleagues sought to understand how the pandemic affected delivery of care to veterans with multiple myeloma. They retrospectively analyzed the electronic medical records of 3,679 veterans with multiple myeloma (MM), representing all the 50 states, who received oral medication for their blood disorder between June 2019 and December 2020.1 Results of the study were presented at the 64th American Society of Hematology Annual Meeting in New Orleans on Dec. 11.
The analysis considered June 2019 to February 2020 to be pre-lockdown and April 2020 to December 2020 to be the post-lockdown period. Visits or consultations by email, phone or telemedicine were considered virtual care. For the study, the team looked at changes in the proportion of in-person visits for all outpatient visits, the number of oral prescriptions for MM medications, number of laboratory tests (creatinine, hemoglobin, serum protein electrophoresis and free light chain ratio) and number of hospital admissions. They used interrupted time series analysis for each outcome to determine the step change between the periods with autoregressive moving average modeling. Each period had nine time points corresponding to months.
Prior to the pandemic lockdown, 93% of medical visits by veterans with MM occurred in person. That number plunged to 68% in April 2020. Interrupted time series analysis demonstrated a 26% drop in the percentage of outpatient visits performed in person when comparing the post-lockdown and pre-lockdown periods.
Further analysis of 37,388 prescriptions showed no statistically significant change in the monthly numbers of prescriptions for ixazomib, lenalidomide or pomalidomide between the periods. However, the number of creatinine, hemoglobin, serum protein electrophoresis laboratory tests performed dropped dramatically. The number of free light chain ratio tests was not significant. Despite less laboratory monitoring, monthly hospital admissions did not rise (-24, [95% CI: +9 to -57], p=0.18).
“The impact on clinical outcomes as a result of increasing virtual care in MM remain to be fully assessed, although the lack of major observed shifts in outpatient scripts and inpatient admissions is encouraging,” the team concluded.
- Su CT, Chen J, Sussman J. Shifts in Multiple Myeloma Care Utilization of Veterans in the COVID-19 Era: Interrupted Time Series Analysis of Veterans Health Administration Data. Blood. 2022 Nov 15;140:7915–6. doi: 10.1182/blood-2022-165966. Epub 2022 Nov 15.