Disparities in the use of telehealth at the onset of the COVID-19 public health emergency

Pierce, Robert P.; Stevermer, James J.

doi:10.1177/1357633x20963893

Cited by 199 publications

(223 citation statements)

References 20 publications

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“…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%

“…A study conducted at four clinics in San Francisco reported that the proportion of primary care visits with minority patients aged ≥65 years decreased after telemedicine implementation [19]. Other studies conducted in the United States have found that telemedicine during COVID-19 was concentrated among younger individuals living in urban areas with higher SES [20][21][22][23]. Yet, these findings show disparities only at one point in the COVID-19 pandemic, and evidence is limited as to how disparities in telemedicine use by age and SES changed as the need for telemedicine persisted during the COVID-19 pandemic.…”

Section: Introductionmentioning

confidence: 99%

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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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Section: Discussionmentioning

confidence: 99%

Section: Introductionmentioning

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

View full text Add to dashboard Cite

show abstract

“…Other investigators have identified concerns regarding disparities in access to telehealth with particular attention to vulnerable populations. 6,7 Lam et al estimated that 13 million seniors (38%) were not ready for video visits, predominantly owing to inexperience with technology, and an additional 20% of older patients were unready for telephone visits because of difficulty hearing, difficulty communicating, or dementia. 8 The high levels of quality and satisfaction from both providers and patients in our study support the notion that time and effort to address all barriers to telehealth access will be good societal investments.…”

Section: Discussionmentioning

confidence: 99%

COVID-19 Telehealth Impact Study

Campion

Ommen

Shah

et al. 2021

TMT

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Importance: This three-part study characterizes the widespread implementation of telehealth during the first year of the COVID-19 pandemic, giving us insight into the role of telehealth as we enter a stage of “new normal” healthcare delivery in the U.S. Objective: The COVID-19 Telehealth Impact Study was designed to describe the natural experiment of telehealth adoption during the pandemic. Using a large claims data stream and surveys of providers and patients, we studied telehealth in all 50 states to inform healthcare leaders. Design, Setting, Participants: In March 2020, the MITRE Corporation and Mayo Clinic founded the COVID-19 Healthcare Coalition (C19HCC), to respond to the pandemic. We report trends using a dataset of over 2 billion healthcare claims covering over 50% of private insurance activity in the U.S. (January 2019-December 2020), along with key elements from our provider survey (July-August 2020) and patient survey (November 2020 - February 2021). Main Outcomes and Measures: There was rapid and widespread adoption of telehealth in Spring 2020 with over 12 million telehealth claims in April 2020, accounting for 49.4% of total health care claims. Providers and patients expressed high levels of satisfaction with telehealth. 75% of providers indicated that telehealth enabled them to provide quality care. 84% of patients agreed that quality of their telehealth visit was good. Results: Peak levels of telehealth use varied widely among states ranging from 74.9% in Massachusetts to 25.4% in Mississippi. Every clinical discipline saw a steep rise with the largest claims volume in behavioral health. Provision of care by out-of-state provider was common at 6.5% (October-December 2020). Providers reported multiple modalities of telehealth care delivery. 74% of patients indicated they will use telehealth services in the future. Conclusions and Relevance: Innovation shown by providers and patients during this period of rapid telehealth expansion constitutes a great natural experiment in care delivery with evidence supporting widespread clinical adoption and satisfaction on the part of both patients and clinicians. The authors encourage continued broad access to telehealth over the next 12 months to allow telehealth best practices to emerge, creating a more effective and resilient system of care delivery.

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“…Because we were interested in the characteristics of those who did not successfully utilize video-based telemedicine, we grouped telephone encounters with in-person encounters; this categorization is supported by recently published studies that suggest that patients receiving telephone care during the pandemic differ significantly from those receiving video care. 7,8 Data elements and collection. Demographic data on all eligible patients, including sex, age, race/ethnicity, insurance status, primary language, and zip code, were abstracted from the UC Davis electronic health record (EHR).…”

Section: Observational Studymentioning

confidence: 99%

Disparities in Telemedicine Use for Subspecialty Diabetes Care During COVID-19 Shelter-In-Place Orders

Haynes

Kompala

Neinstein

et al. 2021

J Diabetes Sci Technol

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Background: During the COVID-19 pandemic, telemedicine use rapidly and dramatically increased for management of diabetes mellitus. It is unknown whether access to telemedicine care has been equitable during this time. This study aimed to identify patient-level factors associated with adoption of telemedicine for subspecialty diabetes care during the pandemic. Methods: We conducted an explanatory sequential mixed-methods study using data from a single academic medical center. We used multivariate logistic regression to explore associations between telemedicine use and demographic factors for patients receiving subspecialty diabetes care between March 19 and June 30, 2020. We then surveyed a sample of patients who received in-person care to understand why these patients did not use telemedicine. Results: Among 1292 patients who received subspecialty diabetes care during the study period, those over age 65 were less likely to use telemedicine (OR: 0.34, 95% CI: 0.22-0.52, P < .001), as were patients with a primary language other than English (OR: 0.53, 95% CI: 0.31-0.91, P = .02), and patients with public insurance (OR: 0.64, 95% CI: 0.49-0.84, P = .001). Perceived quality of care and technological barriers were the most common reasons cited for choosing in-person care during the pandemic. Conclusions: Our findings suggest that, amidst the COVID-19 pandemic, there have been disparities in telemedicine use by age, language, and insurance for patients with diabetes mellitus. We anticipate telemedicine will continue to be an important care modality for chronic conditions in the years ahead. Significant work must therefore be done to ensure that telemedicine services do not introduce or widen population health disparities.

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Disparities in the use of telehealth at the onset of the COVID-19 public health emergency

Cited by 199 publications

References 20 publications

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

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

COVID-19 Telehealth Impact Study

Disparities in Telemedicine Use for Subspecialty Diabetes Care During COVID-19 Shelter-In-Place Orders

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