As a result of mitigation policies and behavioral changes, the COVID-19 pandemic significantly reduced access to primary care, which likely had lasting effects on chronic disease management and health outcomes, particularly for medically and socially vulnerable populations with existing chronic conditions. Newly available longitudinal individual-level data allowed for the rigorous examination of these effects for the first time. Although there was a large and growing body of literature quantifying disparities in outcomes related to COVID-19, relatively less was known about how the pandemic affected access to primary and preventive care, as well as associated health outcomes among medically and socially vulnerable populations.

Understanding how the pandemic affected the utilization of preventive healthcare and management of chronic conditions, such as diabetes mellitus (DM) and hypertension (HTN), as well as the downstream outcomes, was critical to addressing resultant health disparities and mitigating the impact of future disruptions to the healthcare system, as well as advancing interventions and policies to reduce health disparities.

The project leveraged newly available and timely data to examine changes in the receipt of healthcare during the pandemic. The data included commercial health insurance claims, in addition to a unique dataset containing billing data for a large, urban safety-net county health system serving a low-income, largely minority patient population. A special focus was placed on individuals with DM or HTN within those populations.

Using a mixed-methods design, the study examined changes in healthcare utilization and the predictors of disruptions over time. To more comprehensively understand contextual influences related to disruptions in care, complementary qualitative data were obtained through interviews with patients, providers, clinic staff, and health systems leaders from the second-largest municipal health system in the United States, exploring the drivers of underutilization of primary and preventive care during and after the pandemic.