Background Healthcare disparities are well documented across multiple subspecialties in orthopaedics. The widespread implementation of telemedicine risks worsening these disparities if not carefully executed, despite original assumptions that telemedicine improves overall access to care. Telemedicine also poses unique challenges such as potential language or technological barriers that may alter previously described patterns in orthopaedic disparities. Questions/purposes Are the proportions of patients who use telemedicine across orthopaedic services different among (1) racial and ethnic minorities, (2) non-English speakers, and (3) patients insured through Medicaid during a 10-week period after the implementation of telemedicine in our healthcare system compared with in-person visits during a similar time period in 2019? Methods This was a retrospective comparative study using electronic medical record data to compare new patients establishing orthopaedic care via outpatient telemedicine at two academic urban medical centers between March 2020 and May 2020 with new orthopaedic patients during the same 10-week period in 2019. A total of 11,056 patients were included for analysis, with 1760 in the virtual group and 9296 in the control group. Unadjusted analyses demonstrated patients in the virtual group were younger (median age 57 years versus 59 years; p < 0.001), but there were no differences with regard to gender (56% female versus 56% female; p = 0.66). We used self-reported race or ethnicity as our primary independent variable, with primary language and insurance status considered secondarily. Unadjusted and multivariable adjusted analyses were performed for our primary and secondary predictors using logistic regression. We also assessed interactions between race or ethnicity, primary language, and insurance type. Results After adjusting for age, gender, subspecialty, insurance, and median household income, we found that patients who were Hispanic (odds ratio 0.59 [95% confidence interval 0.39 to 0.91]; p = 0.02) or Asian were less likely (OR 0.73 [95% CI 0.53 to 0.99]; p = 0.04) to be seen through telemedicine than were patients who were white. After controlling for confounding variables, we also found that speakers of languages other than English or Spanish were less likely to have a telemedicine visit than were people whose primary language was English (OR 0.34 [95% CI 0.18 to 0.65]; p = 0.001), and that patients insured through Medicaid were less likely to be seen via telemedicine than were patients who were privately insured (OR 0.83 [95% CI 0.69 to 0.98]; p = 0.03). Conclusion Despite initial promises that telemedicine would help to bridge gaps in healthcare, our results demonstrate disparities in orthopaedic telemedicine use based on race or ethnicity, language, and insurance type. The telemedicine group was slightly younger, which we do not believe undermines the findings. As healthcare moves toward increased telemedicine use, we suggest several approaches to ensure that patients of certain racial, ethnic, or language groups do not experience disparate barriers to care. These might include individual patient- or provider-level approaches like expanded telemedicine schedules to accommodate weekends and evenings, institutional investment in culturally conscious outreach materials such as advertisements on community transport systems, or government-level provisions such as reimbursement for telephone-only encounters. Level of Evidence Level III, therapeutic study.

Background and objectivesThe role of telemedicine in the evaluation and treatment of patients with spinal disorders is rapidly expanding, brought on largely by the COVID-19 pandemic. Within this context, the ability of pain specialists to accurately diagnose and plan appropriate interventional spine procedures based entirely on telemedicine visits, without an in-person evaluation, remains to be established. In this study, our primary objective was to assess the relevance of telemedicine to interventional spine procedure planning by determining whether procedure plans established solely from virtual visits changed following in-person evaluation.MethodsWe reviewed virtual and in-person clinical encounters from our academic health system’s 10 interventional spine specialists. We included patients who were seen exclusively via telemedicine encounters and indicated for an interventional procedure with documented procedural plans. Virtual plans were then compared with the actual procedures performed following in-person evaluation. Demographic data as well as the type and extent of physical examination performed by the interventional spine specialist were also recorded.ResultsOf the 87 new patients included, the mean age was 60 years (SE 1.4 years) and the preprocedural plan established by telemedicine, primarily videoconferencing, did not change for 76 individuals (87%; 95% CI 0.79 to 0.94) following in-person evaluation. Based on the size of our sample, interventional procedures indicated solely during telemedicine encounters may be accurate in 79%–94% of cases in the broader population.ConclusionsOur findings suggest that telemedicine evaluations are a generally accurate means of preprocedural assessment and development of interventional spine procedure plans. These findings clearly demonstrate the capabilities of telemedicine for evaluating spine patients and planning interventional spine procedures.

Background: Communication is the foundation of any patient-doctor relationship. Patients who are unable to communicate effectively with physicians because of language barriers may face disparities in accessing orthopaedic care and in the evaluation and treatment of musculoskeletal symptoms. We evaluated whether Spanish-speaking patients face disparities scheduling appointments with orthopaedists via the telephone. Methods: From the American Academy of Orthopaedic Surgeons (AAOS) web site, we randomly selected 50 orthopaedic surgeons’ offices in California specializing in knee surgery. The investigator called eligible offices using a script to request an appointment for a hypothetical Spanish-speaking or English-speaking 65-year-old man with knee pain. The caller randomly selected the patient’s primary language for this first call. A second call was placed a week later requesting an appointment for an identical patient who spoke the alternate language. Results: There was no significant difference between Spanish-speaking and English-speaking patients’ access to appointments with an orthopaedic surgeon (p = 0.8256). Thirty-six English-speaking patients and 35 Spanish-speaking patients were offered an appointment. Twenty-eight Spanish-speaking patients were instructed to bring a friend or family member who could translate for them, 3 were told that the provider spoke sufficient Spanish to communicate without the need for an interpreter, and 4 were told that an interpreter would be made available. Conclusions: We did not detect a disparity between Spanish-speaking and English-speaking patients’ access to appointments with an orthopaedic surgeon. However, 80% of Spanish-speaking patients were asked to rely on nonqualified interpreters for their orthopaedic appointment. This study suggests that orthopaedic offices in California depend heavily on ad hoc interpreters rather than professional interpretation services. It also highlights potential barriers to the provision of qualified interpreters. Additional study is warranted to assess how this lack of adequate utilization of medical interpreters affects the patient-doctor relationship, the quality of care received, and the financial burden on the health system. Clinical Relevance: Optimizing the care that we provide to our patients is a goal of every orthopaedic surgeon. We highlight the importance of utilizing professional interpreters as a means to reduce health-care disparities and overall health-care costs, as well as the importance of improving reimbursement and infrastructure for physicians to utilize qualified interpreters in caring for their limited-English-proficient patients.

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