Disparities in Telehealth use During the COVID-19 Pandemic

Abstract

The coronavirus 2019 pandemic led to rapid expansion of outpatient telemedicine. We sought to characterize patient factors influencing outpatient teleneurology utilization at an urban safety-net hospital. We reviewed all neurology televisits scheduled between June 15, 2020 to April 15, 2021. We used the chi-squared test and multivariate logistic regression to characterize patient demographic factors associated with televisit completion and video use. Of 8875 scheduled televisit encounters, 7530 were completed successfully, 44% via video. Non-English speaking patients, Black patients, Latinx patients, and those with a zip code-linked annual income less than $50,000 were less likely to successfully complete a scheduled televisit. The same demographic groups other than Latinx ethnicity were also less likely to use the video option. Our study found unequal telehealth utilization based on patients’ demographic factors. Currently declining telemedicine reimbursement rates asymmetrically affect audio-only visits, which may limit telehealth access for vulnerable patient populations.

Telemedicine and health access inequalities during the COVID-19 pandemic

“…However, patients of a minority race/ethnicity, older age, uninsured status, and/or whose preferred language was not English were less likely to use telehealth. These findings are generally consistent with the limited literature on telehealth use by social determinants of health [ 22 , 23 ] and suggest that work is needed to educate and develop resources to make telehealth more accessible to diverse populations.…”

Telehealth Expansion, Internet Speed, and Primary Care Access Before and During COVID-19

“…These findings elucidate conflicting literature demonstrating both higher 41,44 and lower 24,45 JAMA Network Open | Health Policy telehealth utilization in racial and ethnic minority groups relative to White individuals. This inconsistency may reflect variation in telehealth uptake by race or ethnicity or moderation by other factors.…”

“…Importantly, we observed greater telehealth uptake among individuals with less education and lower income, boosting the pre-PHE visit advantage for the lowest income group and reducing the pre-PHE visit deficit for the lowest education group. However, research has demonstrated tendency toward audio-only visits in these populations, 21,24,41 and audio-only visits may not offer sufficient quality to support health. Notably, utilization differences by income and education were far smaller than those by geography.…”

“…47 Regarding quality, research has demonstrated lower interest and likelihood of completing video vs phone-only visits among Black, Hispanic or Latino, and Asian individuals relative to White individuals. 19,21,22,24,25,41,45,48 Again, the effectiveness of phoneonly visits is unclear. Regardless, our findings suggest that telehealth expansion is unlikely to fully close primary care utilization gaps by race or ethnicity.…”

“…In the context of telehealth expansion, a digital divide could contribute to inequity in health care utilization . Early studies of telehealth uptake during the pandemic demonstrated disparities in telehealth utilization and modality (audio vs audio and video) by race, ethnicity, and income . Notably, this COVID-19–manifest digital divide rests upon a foundation of unequal access to health care shaped by parallel socioeconomic, environmental, and political determinants of health .…”