Predictors of telemedicine use during the COVID-19 pandemic in the United States–an analysis of a national electronic medical record database

Abstract

Telemedicine utilization increased significantly in the United States during the COVID-19 pandemic. However, there is concern that disadvantaged groups face barriers to access based on single-center studies. Whether there has been equitable access to telemedicine services across the US and during later parts of the pandemic is unclear. This study retrospectively analyzes outpatient medical encounters for patients 18 years of age and older using Healthjump–a national electronic medical record database–from March 1 to December 31, 2020. A mixed effects multivariable logistic regression model was used to assess the association between telemedicine utilization and patient and area-level factors and the odds of having at least one telemedicine encounter during the study period. Among 1,999,534 unique patients 21.6% had a telemedicine encounter during the study period. In the multivariable model, age [OR = 0.995 (95% CI 0.993, 0.997); p<0.001], non-Hispanic Black race [OR = 0.88 (95% CI 0.84, 0.93); p<0.001], and English as primary language [OR = 0.78 (95% CI 0.74, 0.83); p<0.001] were associated with a lower odds of telemedicine utilization. Female gender [OR = 1.24 (95% CI 1.22, 1.27); p<0.001], Hispanic ethnicity or non-Hispanic other race [OR = 1.40 (95% CI 1.33, 1.46);p<0.001 and 1.29 (95% CI 1.20, 1.38); p<0.001, respectively] were associated with a higher odds of telemedicine utilization. During the COVID-19 pandemic, therefore, utilization of telemedicine differed significantly among patient groups, with older and non-Hispanic Black patients less likely to have telemedicine encounters. These findings are relevant for ongoing efforts regarding the nature of telemedicine as the COVID-19 pandemic ends.

Patterns of Telemedicine Use and Glycemic Outcomes of Endocrinology Care for Patients With Type 2 Diabetes

“…Our findings on patient subgroups who rely on telemedicine to access specialty diabetes care are consistent with prior work and identify new characteristics associated with ongoing telemedicine use. We found that younger, female, and urban-dwelling patients were more likely to use telemedicine only, similar to previous data in primary care and endocrinology settings. Black patients in our study were more likely to use telemedicine only, while prior evidence on the association of race and ethnicity with telemedicine use is mixed .…”

“…We found that younger, female, and urban-dwelling patients were more likely to use telemedicine only, similar to previous data in primary care and endocrinology settings. Black patients in our study were more likely to use telemedicine only, while prior evidence on the association of race and ethnicity with telemedicine use is mixed . We found that patients with less complex diabetes were more likely to use telemedicine only.…”

Disparities in Telemedicine Use Among Louisiana Medicaid Beneficiaries During the COVID-19 Pandemic

“…This finding is attributable to both an increased use of telemedicine among non-Hispanic Black beneficiaries and a smaller reduction in in-person service use compared with Hispanic and non-Hispanic White beneficiaries. Like other studies, we found that non-Hispanic Black individuals had lower absolute rates of telemedicine use than White individuals throughout the pandemic,49 however, relative increases in telemedicine use from baseline levels were larger for non-Hispanic Black beneficiaries in Louisiana Medicaid than for non-Hispanic White beneficiaries and remained so through December 2020. Non-Hispanic Black beneficiaries experienced a 28-fold increase in outpatient E&M telemedicine use by December 2020 (53.0 claims per 1000 beneficiaries above baseline level of 1.9, 95% CI: 46.7–59.2) compared with a 22-fold increase for non-Hispanic White beneficiaries (73.3 claims per 1000 beneficiaries above baseline level of 3.3, 95% CI: 64.4–82.1).…”

“…10,[46][47][48] Whether this finding is due primarily to difficulties accessing Spanish-language telemedicine services is not yet clear. 49 We found that non-Hispanic Black Louisiana Medicaid beneficiaries saw smaller relative declines in E&M service use after the onset of the pandemic compared with Hispanic and non-Hispanic White beneficiaries. This finding is attributable to both an increased use of telemedicine among non-Hispanic Black beneficiaries and a smaller reduction in inperson service use compared with Hispanic and non-Hispanic White beneficiaries.…”

“…Several studies have documented lower telemedicine use for Hispanics during the COVID-19 pandemic in settings that were not specific to the Medicaid population 10,46–48. Whether this finding is due primarily to difficulties accessing Spanish-language telemedicine services is not yet clear 49…”