Disparities in Telemedicine Access: A Cross-Sectional Study of a Newly Established Infrastructure during the COVID-19 Pandemic

Abstract

Background The COVID-19 pandemic led to dramatic increases in telemedicine use to provide outpatient care without in-person contact risks. Telemedicine increases options for health care access, but a “digital divide” of disparate access may prevent certain populations from realizing the benefits of telemedicine. Objectives The study aimed to understand telemedicine utilization patterns after a widespread deployment to identify potential disparities exacerbated by expanded telemedicine usage. Methods We performed a cross-sectional retrospective analysis of adults who scheduled outpatient visits between June 1, 2020 and August 31, 2020 at a single-integrated academic health system encompassing a broad range of subspecialties and a large geographic region in the Upper Midwest, during a period of time after the initial surge of COVID-19 when most standard clinical services had resumed. At the beginning of this study period, approximately 72% of provider visits were telemedicine visits. The primary study outcome was whether a patient had one or more video-based visits, compared with audio-only (telephone) visits or in-person visits only. The secondary outcome was whether a patient had any telemedicine visits (video-based or audio-only), compared with in-person visits only. Results A total of 197,076 individuals were eligible (average age = 46 years, 56% females). Increasing age, rural status, Asian or Black/African American race, Hispanic ethnicity, and self-pay/uninsured status were significantly negatively associated with having a video visit. Digital literacy, measured by patient portal activation status, was significantly positively associated with having a video visit, as were Medicaid or Medicare as payer and American Indian/Alaskan Native race. Conclusion Our findings reinforce previous evidence that older age, rural status, lower socioeconomic status, Asian race, Black/African American race, and Hispanic/Latino ethnicity are associated with lower rates of video-based telemedicine use. Health systems and policies should seek to mitigate such barriers to telemedicine when possible, with efforts such as digital literacy outreach and equitable distribution of telemedicine infrastructure.

Trends in the Utilization of Teleneurology and Other Healthcare Resources Prior to and During the COVID-19 Pandemic in an Urban, Tertiary Health System

“…Furthermore, two of the aforementioned studies were conducted in urban tertiary-care settings similar to ours, (5,17) lending further credence to the generalizability of our results. Similar studies in non-neurological populations (10,(22)(23)(24)(25)(26)(27)(28) have shown consistent results with ours, with one study from a large urban health system demonstrating that socially vulnerable populations were more likely to use ED care and office visits in favor of telemedicine care (10). It is interesting to note that multiple studies conducted prior to the COVID-19 pandemic have found that minority status was associated with increased odds of telemedicine utilization in comparison to White patient groups, (29)(30)(31) suggesting that our findings may be in part related to the extraordinary nature of the COVID-19 public health emergency.…”

Reliability of Virtual Physical Performance Assessments in Veterans During the COVID-19 Pandemic

“…Furthermore, there are known characteristics associated with lower rates of telehealth utilization, including advanced age, rural residency, lower socioeconomic status, and racial and ethnic background. 20 Thus, future studies should examine the reliability of virtual physical performance assessments in diverse population to generalize the findings.…”

Longitudinal Trends and Risk Factors for Depressed Mood Among Canadian Adults During the First Wave of COVID-19

“…Moreover, studies on natural disasters, such as hurricane, fires and earthquake also point to long-term effects where lifetime post-traumatic stress disorder rates can be up to 40% higher in disaster survivors compared to controls (32,33). Finally, studies have shown that the pandemic have exacerbated racial, social, and economic disparities (34,35), which could also persist for many years after the pandemic. Given the substantially elevated levels of distressed mood compared with pre-COVID-19 levels, it is important to monitor whether long-term mental health effects persist in the general population.…”