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

Abstract

Background/Objectives The COVID‐19 pandemic necessitated rapid implementation of telemedicine at medical centers across the United States. As telemedicine is expected to persist beyond the pandemic in subspecialties like pediatric dermatology, there is growing concern that socioeconomic factors may contribute to inequitable telemedicine access. This study aims to identify factors associated with disparities in telemedicine use among pediatric dermatology patients during the pandemic. Methods In this single‐center cross‐sectional study, patients less than 18 years old who completed a visit with a pediatric dermatologist via a video telemedicine call or in‐person office visit during the specified time periods were included. Univariate and multivariable analyses were performed to compare demographic factors for (1) patients who had a telemedicine visit versus office visit during June 1, 2020, to January 22, 2021, and (2) patients who had either visit type during June 1, 2020, to January 22, 2021, versus June 1, 2019, to January 2020. Results The independent factors associated with lower odds of telemedicine include identifying as Black/African American, having a non‐English preferred language, and having public insurance, whereas the independent factors reducing overall access to pediatric dermatology care during the pandemic include identifying as Hispanic/Latino and having public insurance. Conclusions Differential telemedicine use in vulnerable communities may be attributed to disparities in technology access and digital literacy and should be addressed at a structural level. If such disparities are identified and adequately remedied, telemedicine can serve as an important tool for expanding access in the field of pediatric dermatology.

Retrospective chart review of patient socioeconomic status and language preference associated with live video telehealth in a pediatric dermatology practice

“…Our finding that NEPL patients are less likely to utilize synchronous teledermatology is in concordance with previously published studies. [2][3][4][5] This suggests our system did not initially have processes to support telehealth access for these patients. This was identified as a digital equity factor when telehealth use grew in 2020, and shortly after this study period, our system added bilingual patient-facing technical support staff and a process for directly dialing-in interpreters during video encounters.…”

“…However, there is growing concern that under‐resourced populations may be left behind with the adoption of telehealth. Prior single‐center retrospective studies identified that non‐English primary language (NEPL), lower income, and public insurance type were associated with less engagement in synchronous teledermatology 2–5 . Findings regarding race were mixed, with some studies showing higher engagement of minority, and specifically Black, patients, in the COVID era, 3,5 while another found less telehealth utilization among Black patients 4 .…”

A Glance at the Practice of Pediatric Teledermatology Pre- and Post–COVID-19: Narrative Review

“…A US study comparing pediatric teledermatology visits scheduled post–COVID-19 with in-person appointments in the same period pre–COVID-19 reported that certain demographic groups such as Spanish-speaking patients were less likely to have teledermatology visits [ 21 ]. Another single center US study [ 22 ] demonstrated via multivariate analyses that independent factors associated with lower rates of telemedicine use were patients identifying as Black/African American and having a non-English preferred language. In this study, patients on public insurance were also found to have significantly lower odds of telemedicine use despite widely expanded telehealth coverage by US health insurance plans.…”

Demographic Data Associated With Digital Inequity Reported in Patient-to-Provider Teledermatology Studies in the United States From 2011 to 2021: Scoping Review

“…Demographic data associated with digital inequity may be an indicator of the likelihood to complete teledermatology visits. Patients greater than 65 years of age, those who reported a non-English language as their primary language, and participants with lower income were less likely to complete teledermatology visits compared to their counterparts [5,6,8,9]. Other studies noted patients older than 65 years and those reporting lower income were less satisfied with the visit experience [10][11][12].…”

“…Demographics that report less access to broadband internet and technology recorded lower telehealth utilization rates during the COVID-19 pandemic. For instance, older age and persons who reported a non-English language as their primary language were associated with fewer completed telemedicine visits [4][5][6]. Inequity in access to telemedicine care exists.…”