Patient-Level Factors Associated with Utilization of Telemedicine Services from a Free Clinic During COVID-19

Abstract

Background: Disparities in telemedicine use by race, age, and income have been consistently documented. To date, research has focused on telemedicine use among patients with adequate insurance coverage. To address this gap, this study identifies patient-level factors associated with telemedicine use during the coronavirus (COVID-19) pandemic among one free clinic network's patients who are underinsured or uninsured. Materials and Methods: Electronic health record data were reviewed for patient-level data on patients seen from March 2020 to September 2020. Patients were grouped by telemedicine use history. We controlled for sociodemographic factors (e.g., age, race/ethnicity) and comorbidities. Logistic regression analyses were conducted. Results: Across 198 adult patients, 56.6% received telemedicine care. Of these, 99.1% elected for audio-only telemedicine instead of video telemedicine. Telemedicine use was more likely among those living within 15 miles of their clinic (adjusted odds ratio [aOR] = 4.43, 95% confidence interval [CI] 1.70-11.53). It was less likely to be used by older patients (aOR = 0.97, 95% CI 0.94-1.00), patients of male sex (aOR = 0.85, 95% CI 0.18-0.92), and those establishing care as a new patient (aOR = 0.01, 95% CI 0.00-0.07). Conclusion:The moderate usage of telemedicine suggests that its implementation in free clinics may be feasible. Solutions specific to patients with smartphone-only internet access are needed to improve the use of video telemedicine as smartphonespecific factors (e.g., data use limits) may influence the ability for underserved patients to receive video telemedicine.

Impact of the COVID-19 Pandemic & Telehealth Implementation in a Student Run Free Clinic

“…Our data indicated there was no difference in the likelihood to return to clinic based on race or ethnicity. This is consistent with other studies which showed no racial or ethnic disparities with telehealth utilization [22,28,29]. Lack of access to healthcare has become increasingly relevant as millions of individuals have recently lost health insurance because of pandemic-related unemployment [30].…”

“…Older patients (≥ 45 years old) were more likely to return to clinic than younger patients (< 45 years old) after the onset of the COVID-19 pandemic. We know that there exists a generational technological divide between older and younger patients in that older patients are less likely to access the internet, use smartphones and have digital literacy [22,[24][25][26]. Therefore, this finding was somewhat surprising as our clinic had switched to telehealth-only available appointments in March 2021 and older patients were thought to be less likely to utilize technology, including telehealth.…”

“…This change evolved as an effort to continue providing care to patients, while simultaneously limiting the risk of disease transmission [10][11][12]. Successful efforts to create and offer telehealth services to uninsured or underinsured patients receiving care from SRFCs nationwide have been described [13][14][15][16][17][18][19][20][21][22]. To date, research has focused primarily on the methods of telehealth implementation in SRFCs.…”

The Impact of Telehealth Adoption During COVID-19 Pandemic on Patterns of Pediatric Subspecialty Care Utilization

“…Interestingly, established patients were more likely to complete telehealth appointments, a finding consistent with other studies demonstrating that—among diverse patient populations during the pandemic—new patients were less likely to use the technology 6 . There was no policy barring new patients from being seen in person; variation in new patient appointments may have depended on acuity and whether laboratory or imaging studies were needed.…”

“…The early phase of the pandemic was associated with reduced in-person pediatric visits 4 . Accordingly, telehealth strategies could generate new opportunities to overcome, or exacerbate, longstanding obstacles to care provision for medically and socially marginalized populations 5 , 6 , 7 . Both federal and state programs seek to expand infrastructure technologies in support of telehealth.…”