Telemedicine and health access inequalities during the COVID-19 pandemic

Abstract

Background During the COVID-19 pandemic, health systems rapidly introduced inhome telehealth to maintain access to care. Evidence is evolving regarding telehealth's impact on health disparities. Our objective was to evaluate associations between socioeconomic factors and rurality with access to ambulatory care and telehealth use during the COVID-19 pandemic. MethodsWe conducted a retrospective study at an academic medical centre in midwestern United States. We included established and new patients who received care during a one-year COVID-19 period vs pre-COVID-19 baseline cohorts. The primary outcome was the occurrence of in-person or telehealth visits during the pandemic. Multivariable analyses identified factors associated with having a health care provider visit during the COVID-19 vs pre-COVID-19 period, as well as having at least one telehealth visit during the COVID-19 period. ResultsAll patient visit types were lower during the COVID-19 vs the pre-COVID-19 period. During the COVID-19 period, 125 855 of 255 742 established patients and 53 973 new patients had at least one health care provider visit, with 41.1% of established and 23.5% of new patients having at least one telehealth visit. Controlling for demographic and clinical characteristics, established patients had 30% lower odds of having any health care provider visit during COVID-19 vs pre-COVID-19 (adjusted odds ratio (aOR) = 0.71, 95% confidence interval (CI) = 0.698-0.71) period. Factors associated with lower odds of having a telehealth visit during COVID-19 period for established patients included older age, self-pay or other insurance vs commercial insurance, Black or Asian vs White race and non-English preferred languages. Female patients, patients with Medicare or Medicaid coverage, and those living in lower income zip codes were more likely to have a telehealth visit. Living in a zip code with higher average internet access was associated with telehealth use but living in a rural zip code was not. Factors affecting telehealth visit during the COVID-19 period for new patients were similar, although new patients living in more rural areas had a higher odds of telehealth use. ConclusionHealthcare inequities existed during the COVID-19 pandemic, despite the availability of in-home telehealth. Patient-level solutions targeted at improving digital literacy, interpretive services, as well as increasing access to stable high-speed internet are needed to promote equitable health care access.The United States (US) declared a public health emergency due to the COVID-19 pandemic on January 13, 2020. Subsequently, the Center for Medicare and Medicaid Services (CMS), followed by other insurance payers, expanded access to and increased reimbursement for telehealth services. Specifically, the 2020 Coronavirus Preparedness and Response Supplement Datta et al.

Rural, Regional, Racial Disparities in Telemedicine Use During the COVID-19 Pandemic Among US Adults: 2021 National Health Interview Survey (NHIS)

“…Our investigation revealed a noteworthy trend wherein the utilization of telemedicine services in rural regions during the COVID-19 pandemic exhibited a proportional decrease as the degree of urbanization diminished (in order of metropolitan central cities, large fringe metropolitan cities, medium and small metropolitan cities, and rural areas). Multiple scholarly inquiries have been dedicated to scrutinizing the disparities in telehealth utilization that manifested during the initial phases of the COVID-19 pandemic, 26,27 and these results are consistent with our outcomes. The findings from prior studies consistently highlighted a discernible pattern: older individuals, non-white populations, and those covered by Medicaid or lacking insurance coverage in rural populations demonstrated a reduced likelihood of engaging in telehealth consultations, in contrast to their counterparts who were white, English-speaking, and possessed commercial insurance.…”

Telemedicine Utilization in the COVID-19 Era: Patterns of Care in Community Urology Practice

“…13 Datta et al found lower rates of telehealth utilization in commercially insured patients (compared to Medicare or Medicaid) and older age patients; higher rates were seen in female patients. 14 We did not find strong associations between provider attributes and telehealth adoption. Our analysis showed that patients with certain diagnoses were more prone than their counterparts to have a televisitdnotably prostate cancer, stone, elevated PSA, hypogonadism, OAB, and erectile dysfunction.…”

Exploring Multiple Dimensions of Access to and Preferences for Telehealth Use

“…Research has consistently found that older individuals are less likely to use telehealth. 9 , 23 , 29 …”