• Jean Yoon, Cheng Chen, Shirley Chao, Emily Wong, and Ann-Marie Rosland.
• From the Health Economics Resource Center, VA Palo Alto Health Care System, Menlo Park, California (JY, EW); Center for Innovation to Implementation, VA Palo Alto Health Care System, Menlo Park, California (JY, CC); University of California, San Francisco, School of Medicine, Department of General Internal Medicine, San Francisco, CA (JY); Department of Pharmacy, VA San Francisco, San Francisco, California (SC); University of California, San Francisco, School of Pharmacy, San Francisco, CA (SC); Center for Health Equity Research and Promotion, VA Pittsburgh Healthcare System, Pittsburgh, Pennsylvania (AMR); Department of Internal Medicine, University of Pittsburgh School of Medicine, Pittsburgh, Pennsylvania (AMR). Jean.Yoon@va.gov.
• J Am Board Fam Med. 2023 Apr 3; 36 (2): 289302289-302.

IntroductionThe COVID-19 pandemic caused potentially disruptive shocks to chronic condition care. We examined how diabetes medication adherence, related hospitalizations, and primary care use changed in high-risk veterans prepandemic and postpandemic.MethodsWe conducted longitudinal analyses on a cohort of high-risk diabetes patients in the Veterans Affairs (VA) health care system. Primary care visits by modality, medication adherence, and VA acute hospitalizations and emergency department (ED) visits were measured. We also estimated differences for subgroups of patients by race/ethnicity, age, and rural/urban location.ResultsPatients were 95% male with mean age 68 years. Prepandemic patients received a mean per quarter of 1.5 in-person primary care visits and 1.3 virtual visits, 0.10 hospitalizations, and 0.22 ED visits, with mean adherence of 0.82. The early pandemic was associated with fewer in-person primary care visits, more virtual visits, fewer hospitalizations and ED visits per patient, and no change in adherence; there were no midpandemic versus prepandemic differences in hospitalizations or adherence. Black and nonelderly patients had lower adherence during the pandemic.ConclusionAdherence to diabetes medications and primary care use remained high for most patients even though virtual care replaced in-person care. Black and nonelderly patients may require additional intervention to address lower adherence.© Copyright by the American Board of Family Medicine.

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