Changes in Outpatient Health Care Use After COVID-19 Infection Among Veterans
Authors: Hebert Paul L. , Kumbier Kyle E. , Smith Valerie A. , Hynes Denise M. , Govier Diana J. , Wong Edwin , Kaufman Brystana G. , Shepherd-Banigan Megan , Rowneki Mazhgan , Bohnert Amy S. B. , Ioannou George N. , Boyko Edward J. , Iwashyna Theodore J. , O’Hare Ann M. , Bowling C. Barrett , Viglianti Elizabeth M. , Maciejewski Matthew L. ,   VA COVID-19 Observational Research Collaboratory (CORC), Admon Andrew , Akgun Kathleen , Anderson Livia , Anderson Stacy , Aslan Mihaela , Au David , Backus Lisa , Bajema Kristina , Baraff Aaron , Batten Lisa , Berkowitz Theodore , Bernstein Taylor , Berry Wyatt Kristin , Bogdan Joseph , Borgerding Joleen , Bosworth Hayden , Boucher Nathan , Burwick Nicholas , Byrd Kaitland , Cabrales Aissa , Cano Jennifer , Chai Wen , Chen Jason , Cheung Kei-Hoi , Crothers Kristina , Cummin Graham , Curtis Jeffrey , Davis Marie , Del Monico Emily , Dennis Paul , Dobalian Aram , Doll Jacob , Dominitz Jason , Eastment McKenna , Fan Vincent , Ferguson Jacqueline , Floyd Breana , Fox Alexandra , Goetz Matthew , Green Pamela , Hastings Susan Nicole , Hauschildt Katrina , Hawkins Eric , Helfand Mark , Hickok Alex , Horowitz Dana , Hough Catherine , Hu Elaine , Ikuta Kevin , Jones Barbara , Jones Makoto , Kamphius Lee , Knight Sara , Korpak Anna , Korpela Peggy , Langa Kenneth , Laundry Ryan , Lavin Stacy , Li Yuli , Lindquist Jennifer , McCready Holly , Meyer Cassie , Michel Martha , Miles Amy , Milne Jessie , Monahan Max , Morelli Daniel , Mutalik Pradeep , Naylor Jennifer , Niederhausen Meike , Newell Summer , Nugent Shannon , Ong Michael , Osborne Thomas , Peterson Matthew , Peterson Alexander , Prescott Hallie , Pura John , Rajeevan Nallakkandi , Reddy Ashok , Rouse Marylena , Saha Somnath , Saini Sameer , Seelye Sarah , Shah Javeed , Shahoumian Troy , Shaukat Aasma , Showalter Whitney , Slatore Christopher , Smith Battista , Smith Nicholas , Streja Elani , Suri Pradeep , Sussman Jeremy , Takata Yumie , Teo Alan , Thomas Eva , Thomas Laura , Tuepker Anais , Turner Aaron , Veigulis Zachary , Vig Elizabeth , Vranas Kelly , Wang Xiao Qing , Wicks Katrina , Winchell Kara , Womer James , Woods Chris , Wysham Katherine , Yan Lei , Zulman Donna 
Published: February 2024

Importance

The association of COVID-19 infection with outpatient care utilization is unclear. Many studies reported population surveillance studies rather than comparing outpatient health care use between COVID-19–infected and uninfected cohorts.

Objective

To compare outpatient health care use across 6 categories of care (primary care, specialty care, surgery care, mental health, emergency care, and diagnostic and/or other care) between veterans with or without COVID-19 infection.

Design, Setting, and Participants

In a retrospective cohort study of Veterans Affairs primary care patients, veterans with COVID-19 infection were matched to a cohort of uninfected veterans. Data were obtained from the Veterans Affairs Corporate Data Warehouse and the Centers for Medicare &amp;amp; Medicaid Services Fee-for-Service Carrier/Physician Supplier file from January 2019 through December 2022. Data analysis was performed from September 2022 to April 2023.

Exposure

COVID-19 infection.

Main Outcomes and Measures

The primary outcome was the count of outpatient visits after COVID-19 infection. Negative binomial regression models compared outpatient use over a 1-year preinfection period, and peri-infection (0-30 days), intermediate (31-183 days), and long-term (184-365 days) postinfection periods.

Results

The infected (202 803 veterans; mean [SD] age, 60.5 [16.2] years; 178 624 men [88.1%]) and uninfected (202 803 veterans; mean [SD] age, 60.4 [16.5] years; 178 624 men [88.1%]) cohorts were well matched across all covariates. Outpatient use in all categories (except surgical care) was significantly elevated during the peri-infection period for veterans with COVID-19 infection compared with the uninfected cohort, with an increase in all visits of 5.12 visits per 30 days (95% CI, 5.09-5.16 visits per 30 days), predominantly owing to primary care visits (increase of 1.86 visits per 30 days; 95% CI, 1.85-1.87 visits per 30 days). Differences in outpatient use attenuated over time but remained statistically significantly higher at 184 to 365 days after infection (increase of 0.25 visit per 30 days; 95% CI, 0.23-0.27 visit per 30 days). One-half of the increased outpatient visits were delivered via telehealth. The utilization increase was greatest for veterans aged 85 years and older (6.1 visits, 95% CI, 5.9-6.3 visits) vs those aged 20 to 44 years (4.8 visits, 95% CI, 4.7-4.8 visits) and unvaccinated veterans (4.5 visits, 95% CI, 4.3-4.6 visits) vs vaccinated veterans (3.2 visits; 95% CI, 3.4-4.8 visits).

Conclusions and Relevance

This study found that outpatient use increased significantly in the month after infection, then attenuated but remained greater than the uninfected cohorts’ use through 12 months, which suggests that there are sustained impacts of COVID-19 infection.