Disparities in telephone and video telehealth engagement during the COVID-19 pandemic

Abstract

Objective The COVID-19 pandemic and subsequent expansion of telehealth may be exacerbating inequities in ambulatory care access due to institutional and structural barriers. We conduct a repeat cross-sectional analysis of ambulatory patients to evaluate for demographic disparities in the utilization of telehealth modalities. Materials and Methods The ambulatory patient population at Oregon Health & Science University (Portland, OR, USA) is examined from June 1 through September 30, in 2019 (reference period) and in 2020 (study period). We first assess for changes in demographic representation and then evaluate for disparities in the utilization of telephone and video care modalities using logistic regression. Results Between the 2019 and 2020 periods, patient video utilization increased from 0.2% to 31%, and telephone use increased from 2.5% to 25%. There was also a small but significant decline in the representation males, Asians, Medicaid, Medicare, and non-English speaking patients. Amongst telehealth users, adjusted odds of video participation were significantly lower for those who were Black, American Indian, male, prefer a non-English language, have Medicaid or Medicare, or older. Discussion A large portion of ambulatory patients shifted to telehealth modalities during the pandemic. Seniors, non-English speakers, and Black patients were more reliant on telephone than video for care. The differences in telehealth adoption by vulnerable populations demonstrate the tendency toward disparities that can occur in the expansion of telehealth and suggest structural biases. Conclusion Organizations should actively monitor the utilization of telehealth modalities and develop best-practice guidelines in order to mitigate the exacerbation of inequities.

Addressing Structural Inequities, a Necessary Step Toward Ensuring Equitable Access to Telehealth for Medication Abortion Care During and Post COVID-19

“…The result is reduced abilities for Black and Latinx communities to connect to telehealth. A comparison of telehealth engagement and modality use (video vs. telephone) pre- and post-pandemic in a mid-size city's academic medical system, found that among telehealth users, Non-English speakers, Black patients, Medicaid, and Medicare-insured were less likely to use video than telephone ( 50 ).…”

Telehealth and the Digital Divide: Identifying Potential Care Gaps in Video Visit Use

“…In response to the COVID-19 pandemic, ambulatory care nationwide expanded telehealth visits, including video visits (VV) and telephone visits (TV). At Oregon Health & Science University, telehealth appointments jumped from 2.5% of all ambulatory visits in 2019 to 51% in 2020 [1]. However, multiple studies have found inequities in this expansion, with reduced proportions of VV to TV in certain racial groups, non-English speakers, seniors and Medicaid beneficiaries [1,2].…”

“…At Oregon Health & Science University, telehealth appointments jumped from 2.5% of all ambulatory visits in 2019 to 51% in 2020 [1]. However, multiple studies have found inequities in this expansion, with reduced proportions of VV to TV in certain racial groups, non-English speakers, seniors and Medicaid beneficiaries [1,2]. These inequities may reflect the impact of the digital divide: the unequal access and use of information technology based on social and geographical characteristics.…”

Using telehealth consultations for healthcare provision to patients from non-Indigenous racial/ethnic minorities: a systematic review

“… 73 Previous studies suggest low digital literacy to be a contributing factor to racial/ethnic disparities among telehealth users. 74 , 75 …”