Demographics associated with US healthcare disparities are exacerbated by the telemedicine surge during the COVID-19 pandemic

Abstract

Introduction As coronavirus disease 2019 (COVID-19) hit the US, there was widespread and urgent implementation of telemedicine programs nationwide without much focus on the impact on patient populations with known existing healthcare disparities. To better understand which populations cannot access telemedicine during the coronavirus disease 2019 pandemic, this study aims to demographically describe and identify the most important demographic predictors of telemedicine visit completion in an urban health system. Methods Patient de-identified demographics and telemedicine visit data ( N = 362,764) between March 1, 2020 and October 31, 2020 were combined with Internal Revenue Service 2018 individual income tax data by postal code. Descriptive statistics and mixed effects logistic regression were used to determine impactful patient predictors of telemedicine completion, while adjusting for clustering at the clinical site level. Results Many patient-specific demographics were found to be significant. Descriptive statistics showed older patients had lower rates of completion ( p < 0.001). Also, Hispanic patients had statistically significant lower rates ( p < 0.001). Overall, minorities (racial, ethnic, and language) had decreased odds ratios of successful telemedicine completion compared to the reference. Discussion While telemedicine use continues to be critical during the coronavirus disease 2019 pandemic, entire populations struggle with access—possibly widening existing disparities. These results contribute large datasets with significant findings to the limited research on telemedicine access and can help guide us in improving telemedicine disparities across our health systems and on a wider scale.

Disparities in telemedicine use during the COVID‐19 pandemic among pediatric dermatology patients

“…These findings corroborate studies in other medical fields, demonstrating the prevalence of inequitable telemedicine access across specialties and patient populations. 3 , 4 , 5 , 6 …”

“… 1 , 2 However, there is growing concern that telemedicine may contribute to health disparities, evidenced by studies in multiple specialties showing that virtual visits were more likely to be utilized by patients who were White, English speaking, and commercially insured. 3 , 4 , 5 , 6 …”

Reasons for Utilizing Telemedicine during and after the COVID-19 Pandemic: An Internet-Based International Study

“…It is of prime importance that public health communication with a specific audience employ adapted and personalized language that considers personal opinions and fears [ 35 ]. The telehealth and telemedicine adoption rates vary among different populations for several reasons, so these campaigns should address specific social and cultural determinants for each targeted subpopulation [ 42 , 83 , 84 ].…”

“…Decision trees are an easy-to-understand model comprising a set of cascading questions overcoming Simpson’s paradox [ 41 ] by disclosing nonlinear interactions between predictors. This allows a better comprehension of the main variables involved in the intended use of telemedicine after the COVID-19 pandemic [ 42 ].…”

Neuroethics in the Era of Teleneurology

“…If not proactively addressed, these disparities may preclude equitable access to teleneurology services across diverse populations and potentially exacerbate pre-existing health care inequalities, particularly among underserved minority populations, elderly patients, and patients with low health literacy or digital literacy. 69 70 71 72 73 74 75 76 77 78 79 80 81 82 83 84 85 86 87 88 89 It is estimated that over one in four Americans lack access to requisite technologies or digital literacy to engage in telemedicine visits, raising concerns that patients who are most vulnerable and in need of enhanced health care access may be the ones who are least likely to benefit from the advent of telemedicine technologies. 90 These issues are further magnified in considering access to teleneurology in less developed countries.…”