Growth of Ambulatory Virtual Visits and Differential Use by Patient Sociodemographics at One Urban Academic Medical Center During the COVID-19 Pandemic: Retrospective Analysis

Abstract

Background Despite widespread interest in the use of virtual (ie, telephone and video) visits for ambulatory patient care during the COVID-19 pandemic, studies examining their adoption during the pandemic by race, sex, age, or insurance are lacking. Moreover, there have been limited evaluations to date of the impact of these sociodemographic factors on the use of telephone versus video visits. Such assessments are crucial to identify, understand, and address differences in care delivery across patient populations, particularly those that could affect access to or quality of care. Objective The aim of this study was to examine changes in ambulatory visit volume and type (ie, in-person vs virtual and telephone vs video visits) by patient sociodemographics during the COVID-19 pandemic at one urban academic medical center. Methods We compared volumes and patient sociodemographics (age, sex, race, insurance) for visits during the first 11 weeks following the COVID-19 national emergency declaration (March 15 to May 31, 2020) to visits in the corresponding weeks in 2019. Additionally, for visits during the COVID-19 study period, we examined differences in visit type (ie, in-person versus virtual, and telephone versus video visits) by sociodemographics using multivariate logistic regression. Results Total visit volumes in the COVID-19 study period comprised 51.4% of the corresponding weeks in 2019 (n=80,081 vs n=155,884 visits). Although patient sociodemographics between the COVID-19 study period in 2020 and the corresponding weeks in 2019 were similar, 60.5% (n=48,475) of the visits were virtual, compared to 0% in 2019. Of the virtual visits, 61.2% (n=29,661) were video based, and 38.8% (n=18,814) were telephone based. In the COVID-19 study period, virtual (vs in-person) visits were more likely among patients with race categorized as other (vs White) and patients with Medicare (vs commercial) insurance and less likely for men, patients aged 0-17 years, 65-74 years, or ≥75 years (compared to patients aged 18-45 years), and patients with Medicaid insurance or insurance categorized as other. Among virtual visits, compared to telephone visits, video visits were more likely to be adopted by patients aged 0-17 years (vs 18-45 years), but less likely for all other age groups, men, Black (vs White) patients, and patients with Medicare or Medicaid (vs commercial) insurance. Conclusions Virtual visits comprised the majority of ambulatory visits during the COVID-19 study period, of which a majority were by video. Sociodemographic differences existed in the use of virtual versus in-person and video versus telephone visits. To ensure equitable care delivery, we present five policy recommendations to inform the further development of virtual visit programs and their reimbursement.

Pediatric Subspecialty Adoption of Telemedicine Amidst the COVID-19 Pandemic: An Early Descriptive Analysis

“…It is also known that differences in patient demographics such as race, language, insurance status, and neighborhood broadband status may impact the use of health-related technologies including patient portals and TM (8,9). Inequities in accessing TM have also been reported in adult patients during the COVID-19 pandemic, with poorer, non-English-speaking, and Latinx patients having less TM use (10).…”

Teaching Telemedicine: The Next Frontier for Medical Educators

“…Despite these benefits, telemedicine may risk further fragmentation of care if not implemented correctly [22]. In particular, it raises issues related to equitable care delivery and concerns of exacerbating the digital divide, where access to the technology required for telehealth differs along sociodemographic lines [10][11][12]. Further, the virtual nature of telemedicine has the potential to hinder patient-provider communication; for example, in one study where patients expressed concerns about errors in their care due to the lack of physical exam, they reported feeling less involved during the visit and had difficulty finding opportunities to speak [23].…”

“…Since telemedicine will likely be part of our clinical landscape in the future, clinician educators will need educational strategies to teach patient-centered virtual visit practices to trainees. Additionally, since patient-centeredness is intricately tied to care access and health equity [7], clinician educators and trainees alike must learn how to approach telemedicine from an individualized, patient-centered standpoint, understanding how it can both enhance care for some vulnerable communities [8,9] as well as ways it can widen health care disparities for others [10][11][12][13]. With this in mind, we will discuss what is known about patient-centered care, particularly as it applies to virtual visits.…”

Reimbursement for Teledermatology During the COVID-19 Public Health Emergency: Change Has Come, But Will It Stay?

“…The CMS has stated in its comments that it is looking at this issue closely and may establish certain guardrails to ensure quality of care is maintained. 1 Telephone/audio-only visits also may come under further scrutiny, but research has supported the concept that patients who are more likely to gain access through audio-only modalities are older, Medicare/Medicaid (vs commercial), and Black (vs White) patients, 5 so it would indeed introduce an unfair barrier to access if such coverage was rolled back.…”