Variation In Telemedicine Use And Outpatient Care During The COVID-19 Pandemic In The United States

Patel, Sadiq; Mehrotra, Ateev; Huskamp, Haiden A.; Uscher‐Pines, Lori; Ganguli, Ishani; Barnett, Michael L.

doi:10.1377/hlthaff.2020.01786

Cited by 356 publications

(298 citation statements)

References 15 publications

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“…This difference likely reflects different timeframes, as prior studies examined only the first half of 2020, during which time restrictions on ambulatory visits placed in response to the initial pandemic response, were more common. Furthermore, prior studies of telehealth use for general outpatient care have shown that older adults were less likely to complete telehealth visits compared to younger adults 10,11 although the current study documents similar use of telehealth across ages for TCM visits specifically.…”

Section: Discussioncontrasting

confidence: 51%

Trends in telehealth and in‐person transitional care management visits during the COVID‐19 pandemic

Anderson

O’Donoghue

Dechen

et al. 2021

J American Geriatrics Society

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Section: Discussioncontrasting

confidence: 51%

Trends in telehealth and in‐person transitional care management visits during the COVID‐19 pandemic

Anderson

O’Donoghue

Dechen

et al. 2021

J American Geriatrics Society

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“…For example, young patients may have fewer comorbidities and seek care for milder conditions compared to middle-aged or older adults. Young patients also may be less likely to need blood tests or diagnostic imaging, which require patients to physically visit a health care facility [ 40 , 41 ]. Finally, younger individuals may be less likely to have disabilities and sensory barriers that could be hurdles to telemedicine use [ 14 ].…”

Section: Discussionmentioning

confidence: 99%

“…Studies that were conducted prior to the expansion of telemedicine use in response to the COVID-19 pandemic have reported that younger patients are more likely to use telemedicine, whereas these studies showed mixed results regarding the disparities by area income level and urbanicity of residence. Studies that were conducted after the COVID-19 pandemic found that telemedicine use overall [ 41 , 45 , 46 ] and for geriatric care [ 21 ], primary care [ 19 , 22 , 47 ], or otolaryngological care [ 23 ] was concentrated among younger individuals living in urban high-income areas. Yet, the timeframe used in these studies represented only one early point in the COVID-19 pandemic, and the studies did not focus on the change over time of age and social disparities in telemedicine use.…”

Section: Discussionmentioning

confidence: 99%

Age and Social Disparities in the Use of Telemedicine During the COVID-19 Pandemic in Japan: Cross-sectional Study

Miyawaki¹,

Tabuchi²,

Ong³

et al. 2021

J Med Internet Res

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Background The use of telemedicine outpatient visits has increased dramatically during the COVID-19 pandemic in many countries. Although disparities in access to telemedicine by age and socioeconomic status (SES) have been well-documented, evidence is limited as to how these disparities changed during the COVID-19 pandemic. Moreover, the equity of patient access to telemedicine has been scarcely reported in Japan, despite the huge potential for telemedicine expansion. Objective We aimed to investigate changes due to age and SES disparities in telemedicine use during the COVID-19 pandemic in Japan. Methods Using data from a large internet survey conducted between August 25 and September 30, 2020, in Japan, we examined the associations of participant age and SES (educational attainment, urbanicity of residence, and income level) with their telemedicine use in the following two time periods during the pandemic: April 2020 and August-September 2020. Results Of the 24,526 participants aged 18 to 79 years (50.8% [n=12,446] women), the proportion of individuals who reported using telemedicine increased from 2.0% (n=497) in April 2020 to 4.7% (n=1159) in August-September 2020. After adjusting for potential confounders, younger individuals were more likely to use telemedicine than older individuals in April 2020. Although this pattern persisted in August-September 2020, we also observed a substantial increase in telemedicine use among individuals aged 70 to 79 years (adjusted rates, 0.2% in April 2020 vs 3.8% in August-September 2020; P<.001 after multiple comparisons). We found disparities in telemedicine use by SES in August-September 2020 that did not exist in April 2020. In August-September 2020, individuals with a university degree were more likely to use telemedicine than those with a high school diploma or less (adjusted rates, 6.6% vs 3.5%; P<.001). Individuals living in urban areas exhibited higher rates of telemedicine use than those living in rural areas only in August-September 2020 (adjusted rates, 5.2% vs 3.8%; P<.001). Disparities in telemedicine use by income level were not observed in either time period. Conclusions In general, younger individuals increased their use of telemedicine compared to older individuals during the pandemic, although individuals in their 70s also increased their use of telemedicine. Disparities in telemedicine use by educational attainment and urbanicity of residence widened during the COVID-19 pandemic.

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“…The incorporation of telemedicine services, narrowly defined as remote synchronous audio-video encounters, has been considered a possible resolution to access to care issues for rural patients [2,[5][6][7]. Despite early demonstrations of telemedicine effectiveness including 'hub-and-spoke' models of access to specialist care [8], uptake of telemedicine services had been relatively limited across the general population before the COVID-19 pandemic.…”

Section: Introductionmentioning

confidence: 99%

“…Despite early demonstrations of telemedicine effectiveness including 'hub-and-spoke' models of access to specialist care [8], uptake of telemedicine services had been relatively limited across the general population before the COVID-19 pandemic. The rapid incorporation of telemedicine into ambulatory care beginning in March 2020 has been widespread, with a rapid transition to telemedicine now attenuating to a 'blend' of telemedicine and in-person care [7]. The western region of Tennessee, or westernmost grand division, is an agricultural region geographically and culturally distinct from the other grand divisions of Tennessee (middle and east Tennessee), anchored by the city of Memphis in the southwest and the Mississippi and Tennessee rivers forming the western and eastern borders, respectively [9].…”

Section: Introductionmentioning

confidence: 99%

The Association of Broadband Internet Access and Telemedicine Utilization in rural Western Tennessee: an observational study

Quinton

Ong

Vangala

et al. 2021

BMC Health Serv Res

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Background Broadband access has been highlighted as a national policy priority to improve access to care in rural communities. Objective To determine whether broadband internet availability was associated with telemedicine adoption among a rural patient population in western Tennessee. Methods Observational study using electronic medical record data from March 13th, 2019 to March 13th, 2021. Multivariable logistic regression incorporating individual-level characteristics with broadband availability, income, educational attainment, and primary care physician supply at the zip code level, and rural status as determined at the county level. Setting Single health system in western Tennessee. Participants Adult patients with one or more in-person or remote encounter in a health system in western Tennessee and residing in western Tennessee between March 13th, 2019 and March 13th, 2021 (N = 54,688). Outcome measures Completion of one or more video encounters in the year following March 13th, 2020 (N = 3199; 7%). Our primary characteristic of interest was the proportion of residents in each zip code with access to the internet meeting the Federal Communications Commission definition of broadband access, adjusting for age, gender, race, income, educational attainment, insurance type, rural status, and primary care provider supply. Results Patients in a rural western Tennessee health system were predominantly white (79%), residing in rural zip codes (73%) with median household incomes ($52,085) less than state and national averages. Patients residing in a zip code where there is 80 to 100% broadband access compared to 0 to 20% were more likely in the year following March 13th, 2020 to have completed both telemedicine and in-person visits ([OR; 95% CI] 1.57; 1.29, 1.94), completed only telemedicine visits (2.26; 1.71, 2.97), less likely to have only completed in-person visits (0.81; 0.74, 0.89), but no more or less likely to have accessed no care (1.07; 0.97, 1.18). Discussion The availability of broadband internet was shown to be one of many factors associated with the utilization of telemedicine for a rural, working-class community after March 13th, 2020. Conclusions Access to broadband internet is a determinant of access to telemedicine for patients in rural communities and should be a priority for policymakers interested in improving health and access to care for rural patients.

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Variation In Telemedicine Use And Outpatient Care During The COVID-19 Pandemic In The United States

Cited by 356 publications

References 15 publications

Trends in telehealth and in‐person transitional care management visits during the COVID‐19 pandemic

Trends in telehealth and in‐person transitional care management visits during the COVID‐19 pandemic

Age and Social Disparities in the Use of Telemedicine During the COVID-19 Pandemic in Japan: Cross-sectional Study

The Association of Broadband Internet Access and Telemedicine Utilization in rural Western Tennessee: an observational study

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