Age and socioeconomic status affect access to telemedicine at an urban level 1 trauma center

Abstract

Objectives: Despite clinical and economic advantages, routine utilization of telemedicine remains uncommon. The purpose of this study was to examine potential disparities in access and utilization of telehealth services during the rapid transition to virtual clinic during the coronavirus pandemic. Design: Retrospective chart review. Setting: Outpatient visits (in-person, telephone, virtual—Doxy.me) over a 7-week period at a Level I Trauma Center orthopaedic clinic. Intervention: Virtual visits utilizing the Doxy.me platform. Main Outcome Measures: Accessing at least 1 virtual visit (“Virtual”) or having telephone or in-person visits only (“No virtual”). Methods: All outpatient visits (in-person, telephone, virtual) during a 7-week period were tracked. At the end of the 7-week period, the electronic medical record was queried for each of the 641 patients who had a visit during this period for the following variables: gender, ethnicity, race, age, payer source, home zip code. Data were analyzed for both the total number of visits (n = 785) and the total number of unique patients (n = 641). Patients were identified as accessing at least 1 virtual visit (“Virtual”) or having telephone or in-person visits only (“No virtual”). Results: Weekly totals demonstrated a rapid increase from 0 to greater than 50% virtual visits by the third week of quarantine with sustained high rates of virtual visits throughout the study period. Hispanic and Black/African American patients were able to access virtual care at similar rates to White/Caucasian patients. Patients of ages 65 to 74 and 75+ accessed virtual care at lower rates than patients ≤64 ( P = .003). No difference was found in rates of virtual care between payer sources. A statistically significant difference was found between patients from different zip codes ( P = .028). Conclusion: A rapid transition to virtual clinic can be performed at a level 1 trauma center, and high rates of virtual visits can be maintained. However, disparities in access exist and need to be addressed.

Virtual fall program assessment for frail Canadian community-dwelling older adults: Examining equitable accessibility

“…For example, a larger proportion of the VC required assistance with > 3 IADLs and had more cognitive impairment suggestive of the inability to independently drive to in-person programs, 23 yet virtual appointments remained accessible to these patients. Previously, age has been associated with decreased accessibility to virtual care 18 ; however, our findings reveal high-SES frail older adults are able to continue accessing FPP treatment following virtual assessments. This demonstrates the existing equity within the virtual FPP as a population both frail and elderly continued to access supportive care.…”

“…Markers of high SES have been found to improve older adults’ ability to access and navigate virtual care despite frailty. 18 One noticeable difference between the cohort demographics was a greater number of female participants. Females have a longer life expectancy than males, and high-SES females tend to seek care more often than males.…”

Telemedicine in orthopaedics and trauma surgery during the first year of COVID pandemic: a systematic review

“…Several studies are available all of them showing high patient and physician satisfaction, however not equal to face-to-face examination [ 21 , 50 – 52 ]. Especially older patients show lower acceptance rates [ 22 , 53 ]. Looking into a third-party perspective, Ariza-Vega et al [ 41 ] investigated 44 family caregivers who had an older family member with a previous hip fracture.…”

The environmental impact of surgical telemedicine: life cycle assessment of virtual vs. in-person preoperative evaluations for benign foregut disease

“…Similarly, pediatric surgical clinics have found that patients with public insurance or without insurance and non-white patients were more likely to miss telemedicine appointments [ 36 , 37 ]. In addition to socioeconomic differences, older age was found in some studies to be associated with lower telemedicine usage [ 38 , 39 ]. However, telemedicine may reduce barriers to care in certain complex and lengthy surgical evaluations, such as living kidney donors.…”