Comparative Effectiveness of Telehealth Versus In-Person Primary Care for the Adults Living with Intellectual Disabilities and Obesity: Insights of a Provider Shortage State in the United States

Abstract

Background

: Telehealth has emerged as an alternative health care delivery in primary clinical settings. We have investigated the comparative effectiveness of telehealth and in-person primary care for the individuals with intellectual disability (ID) and obesity.

Methods:

This study utilized the administrative database of the accountable care organization and the Nevada Medicaid program between January 1 and December 31, 2021. A total of 73 individuals with obese ID were chosen. Subsequently, a computer-assisted demographics (age, gender, race) and type of ID paired matching process was carried out for the in-person primary care visits of obese ID individuals (n = 146). The outcome measurements were (1) behavioral counseling for obesity, (2) number of hospitalizations, and (3) transitional care management (TCM) after hospital discharge between telehealth and in-person visit groups.

Results:

Telehealth visit (21.9%, 16/73) was more likely to have obesity counseling than in-person visit (9.6%, 14/146; χ² = 6.25, p = 0.01). There was no difference in the number of hospitalizations between telehealth visit and in-person visit groups (mean ± standard deviation, 0.53 ± 0.94 vs. 0.57 ± 0.95; t = −0.30, p = 0.76). Telehealth visit (45.5%, 10/22) was more likely to have TCM after hospital discharge than in-person visit (17.4%, 8/46; χ² = 6.28, p = 0.01).

Conclusions

: Findings suggest that telehealth primary care for individuals with obese adults with ID was associated with increasing odds of obesity counseling and timely communication after hospital discharge. The association between increased access to TCM and telehealth might generate more clinical revenues that can motivate providers to assure the care sustainability to these individuals. Both IDD and telehealth workforce training curriculum development and implementation are warranted for primary care providers who are not familiar with both IDD care and telehealth.