Disparities in Outpatient and Telehealth Visits During the COVID-19 Pandemic in a Large Integrated Health Care Organization: Retrospective Cohort Study

Abstract

Background Dramatic decreases in outpatient visits and sudden increases in telehealth visits were observed during the COVID-19 pandemic, but it was unclear whether these changes differed by patient demographics and socioeconomic status. Objective This study aimed to assess the impact of the pandemic on in-person outpatient and telehealth visits (telephone and video) by demographic characteristics and household income in a diverse population. Methods We calculated weekly rates of outpatient and telehealth visits by age, sex, race/ethnicity, and neighborhood-level median household income among members of Kaiser Permanente Southern California (KPSC) from January 5, 2020, to October 31, 2020, and the corresponding period in 2019. We estimated the percentage change in visit rates during the early pandemic period (March 22 to April 25, 2020) and the late pandemic period (October 4 to October 31, 2020) from the prepandemic period (January 5 to March 7, 2020) in Poisson regression models for each subgroup while adjusting for seasonality using 2019 data. We examined if the changes in visit rates differed by subgroups statistically by comparing their 95% CIs. Results Among 4.56 million KPSC members enrolled in January 2020, 15.0% (n=682,947) were ≥65 years old, 51.5% (n=2,345,020) were female, 39.4% (n=1,795,994) were Hispanic, and 7.7% (n=350,721) lived in an area of median household income <US $40,000. Increases in telehealth visits during the pandemic varied across subgroups, while decreases in outpatient visits were similar, except by age. Among age groups, the ≥65 years population had the least increase in telehealth visits (236.6%, 95% CI 228.8%-244.5%), with 4.9 per one person-year during the early pandemic period versus 1.5 per one person-year during the prepandemic period. During the same periods, across racial/ethnic groups, Hispanic individuals had the largest increase in telehealth visits (295.5%, 95% CI 275.5%-316.5%). Across income levels, telehealth visits in the low-income group increased the most (313.5%, 95% CI 294.8%-333.1%). The rate of combined outpatient and telehealth visits in the Hispanic, non-Hispanic Black, and low-income groups returned to prepandemic levels by October 2020. Conclusions The Hispanic group and low-income group had the largest percentage increase in telehealth utilization in response to the COVID-19 pandemic. The use of virtual care potentially mitigated the impact of the pandemic on health care utilization in these vulnerable populations.

Use and usability of GP online services: a mixed-methods sequential study, before and during the COVID-19 pandemic, based on qualitative interviews, analysis of routine eConsult usage and feedback data, and assessment of GP websites in Devon and Cornwall, England

“…We do not know what the continued face-to-face or telephone consulting rates were for older patients, but it is clear that online contact was much less than ‘normal’ and so it seems likely that older patients had diminished accessibility online. This corresponds with data for telehealth from the USA 22…”

“…This corresponds with data for telehealth from the USA. 22 A marked finding of the usage data is the much greater use (more than double) of eConsult by women than men. The idea that women consult more than men is indeed not new; in 2010 Wang et al found that men consulted 32% less often than women, 23 while in 2018 Mukhtar et al 21 found that women's consultation rates were 21% higher than males.…”

Differences in Outpatient Health Care Utilization 12 Months after COVID-19 Infection by Race/Ethnicity and Community Social Vulnerability

“…For example, mobile health clinics have been shown to be a cost-effective approach for improving health care access in underserved communities [ 42 ]. The nature of the pandemic has also given rise to virtual care delivery models, which, depending on how they are implemented, have the potential to help mitigate disparities in health care access [ 5 , 43 ]. Even so, it remains salient that inequities in our health systems are deeply entrenched and rooted in structural inequalities that require structural solutions to improve upon the status quo.…”

“…As critical care units struggled to expand capacity as waves of infections surged, public concern around safety coupled with the deprioritization of nonurgent health care led to a substantial decrease in overall patient volumes. Research conducted in the early months of the pandemic found mixed patterns of care utilization that differed for patients living in areas of lower income and predominantly comprising racial/ethnic minorities, with disparities increasing for some and closing for other traditionally marginalized groups [ 4 , 5 ]. Given the ongoing scale, scope, and duration of the pandemic, it is essential to expand our understanding around equity of health care access and utilization, particularly for those diagnosed with COVID-19.…”

Changes in incidence rates of outcomes of interest in vaccine safety studies during the COVID-19 pandemic

“…COVID-19 caused an abrupt drop in the use of in-person health care, accompanied by a corresponding surge in telehealth (TH) services [1] , [2] , [3] , [4] , [5] , [6] . In-person visits including inpatient (IP), Emergency Department (ED), and outpatient (OP) visits have traditionally been the main venues for patients to seek care.…”