Background The COVID-19 pandemic led to dramatic increases in telemedicine use to provide outpatient care without in-person contact risks. Telemedicine increases options for health care access, but a “digital divide” of disparate access may prevent certain populations from realizing the benefits of telemedicine. Objectives The study aimed to understand telemedicine utilization patterns after a widespread deployment to identify potential disparities exacerbated by expanded telemedicine usage. Methods We performed a cross-sectional retrospective analysis of adults who scheduled outpatient visits between June 1, 2020 and August 31, 2020 at a single-integrated academic health system encompassing a broad range of subspecialties and a large geographic region in the Upper Midwest, during a period of time after the initial surge of COVID-19 when most standard clinical services had resumed. At the beginning of this study period, approximately 72% of provider visits were telemedicine visits. The primary study outcome was whether a patient had one or more video-based visits, compared with audio-only (telephone) visits or in-person visits only. The secondary outcome was whether a patient had any telemedicine visits (video-based or audio-only), compared with in-person visits only. Results A total of 197,076 individuals were eligible (average age = 46 years, 56% females). Increasing age, rural status, Asian or Black/African American race, Hispanic ethnicity, and self-pay/uninsured status were significantly negatively associated with having a video visit. Digital literacy, measured by patient portal activation status, was significantly positively associated with having a video visit, as were Medicaid or Medicare as payer and American Indian/Alaskan Native race. Conclusion Our findings reinforce previous evidence that older age, rural status, lower socioeconomic status, Asian race, Black/African American race, and Hispanic/Latino ethnicity are associated with lower rates of video-based telemedicine use. Health systems and policies should seek to mitigate such barriers to telemedicine when possible, with efforts such as digital literacy outreach and equitable distribution of telemedicine infrastructure.

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Background The potential benefits of utilizing rapid influenza diagnostic tests (RIDT) in urgent care facilities on clinical care and prescribing practices are understudied. We compared antiviral and antibiotic prescribing, imaging, and laboratory ordering in clinical encounters with and without RIDT results. Methods Our study compared patients with acute respiratory infection (ARI) symptoms who received an RIDT and patients who did not at two urgent care facilities. Primary analysis using one-to-one exact matching resulted in 1145 matched pairs to which McNemar’s 2x2 tests were used to assess association between the likelihood of prescribing, imaging or laboratory ordering, and RIDT use. Secondary analysis compared the same outcomes using logistic regression among the RIDT-tested population between participants who tested negative (RIDT(-)) and positive (RIDT(+)). Results Primary analysis identified that compared to patients without RIDT testing, RIDT(+) patients were more likely to be prescribed antivirals (OR:10.23; 95% CI:5.78-19.72) and less likely to be prescribed antibiotics (OR:0.15; 95% CI:0.08-0.27). Comparing all RIDT-tested participants to all non-RIDT-tested participants, RIDT use increased antiviral prescribing odds (OR:3.07; 95% CI:2.25-4.26) and reduced antibiotic prescribing odds (OR:0.52; 95% CI:0.43-0.63). The secondary analysis identified an increased odds of prescribing antivirals (OR:28.21; 95% CI:18.15-43.86; P <0.0001) and a decreased odds of prescribing antibiotics (OR:0.20; 95% CI:0.13-0.30; P <0.0001) for RIDT(+) participants compared to RIDT(-). Conclusions Utilization of RIDTs in patients presenting to urgent care with ARI symptoms influences clinician diagnostic and treatment decision-making, which could lead to improved patient outcomes, population-level reductions in influenza burden, and a decreased threat of antibiotic resistance.

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