Telemedicine disparities during <scp>COVID</scp>‐19: Provider offering and individual technology availability

Jacobs, Molly; Ellis, Charles

doi:10.1111/jgs.17280

Cited by 11 publications

(4 citation statements)

References 4 publications

(7 reference statements)

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“…Race and ethnicity was a significant factor for all three outcomes, with Black Non-Hispanic Medicare enrollees being less likely to be offered telehealth services during the COVID-19 pandemic, more likely to be offered telehealth services before the COVID-19 pandemic, and more likely to use telehealth services during COVID-19 compared to White Non-Hispanic enrollees. These results may seem contradictory; however, they support previous research that shows that telehealth services were available to Black Non-Hispanic Medicare enrollees at higher rates than to White Non-Hispanic enrollees before COVID-19, but that during the COVID-19 pandemic, telehealth coverage subsequently increased the most for White Non-Hispanic enrollees and increased the least for Black Non-Hispanic enrollees, leading to a disparity in telehealth coverage ( 26 ). Previous research also shows that, despite telehealth services being less available to them during COVID-19, Black Medicare enrollees were more likely to use telehealth services during COVID-19 than White enrollees ( 12 ), while other research shows that Black patients were more likely to use audio-only telehealth services compared to video visits during COVID-19 ( 27 ).…”

Section: Discussionsupporting

confidence: 61%

Availability and use of telehealth services among patients with ADRD enrolled in traditional Medicare vs. Medicare advantage during the COVID-19 pandemic

Wang,

Seale,

Chen

2024

Front. Public Health

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BackgroundThe objective of this study was to examine differences in availability and use of telehealth services among Medicare enrollees according to Alzheimer’s disease and related dementias (ADRD) status and enrollment in Medicare Advantage (MA) versus Traditional Medicare (TM) during the period surrounding the COVID-19 pandemic.MethodsThis was a retrospective cross-sectional analysis of data from community-dwelling MA and TM enrollees with and without ADRD from the Medicare Current Beneficiary Survey (MCBS) Fall 2020 and Winter 2021 COVID-19 Supplement Public Use Files. We examined self-reported availability of telehealth service before and during the COVID-19 pandemic and use of telehealth services during COVID-19. We analyzed marginal effects under multivariable logistic regression.ResultsThere were 13,700 beneficiaries with full-year enrollment in MA (6,046) or TM (7,724), 518 with ADRD and 13,252 without ADRD. Telehealth availability during COVID-19 was positively associated with having a higher income (2.81 pp. [percentage points]; 95% CI: 0.57, 5.06), having internet access (7.81 pp.; 95% CI: 4.96, 10.66), and owning telehealth-related technology (3.86; 95% CI: 1.36, 6.37); it was negatively associated with being of Black Non-Hispanic ethnicity (−8.51 pp.; 95% CI: −12.31, −4.71) and living in a non-metro area (−8.94 pp.; 95% CI: −13.29, −4.59). Telehealth availability before COVID-19 was positively associated with being of Black Non-Hispanic ethnicity (9.34 pp.; 95% CI: 3.74, 14.94) and with enrollment in MA (4.72 pp.; 95% CI: 1.63, 7.82); it was negatively associated having dual-eligibility (−5.59 pp.; 95% CI: −9.91, −1.26). Telehealth use was positively associated with being of Black Non-Hispanic ethnicity (6.47 pp.; 95% CI: 2.92, 10.01); it was negatively associated with falling into the age group of 75+ years (−4.98 pp.; 95% CI: −7.27, −2.69) and with being female (−4.98 pp.; 95% CI: −7.27, −2.69).ConclusionTelehealth services were available to and used by Medicare enrollees with ADRD to a similar extent compared to their non-ADRD counterparts. Telehealth services were available to MA enrollees to a greater extent before COVID-19 but not during COVID-19, and this group did not use telehealth services more than TM enrollees during COVID-19.

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Section: Discussionsupporting

confidence: 61%

Availability and use of telehealth services among patients with ADRD enrolled in traditional Medicare vs. Medicare advantage during the COVID-19 pandemic

Wang,

Seale,

Chen

2024

Front. Public Health

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“…14 A study of telemedicine technologies among Medicare beneficiaries revealed that compared with other racial groups, Black patients experienced the lowest rate of increase in telemedicine availability during the pandemic. 15 Our study provides insights on inequities in telemedicine visit uptake among patients with different hematologic cancers receiving diverse types of treatments across various geographic regions in US during the critical time of early pandemic.…”

Section: Discussionmentioning

confidence: 95%

Racial Disparities in Telemedicine Uptake during the COVID-19 Pandemic among Patients with Hematologic Malignancies in the United States

Neparidze,

W. Lau,

Wang

et al. 2024

MRAJ

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Background: The COVID-19 pandemic impacted healthcare visit trends, transitioning care to utilize telemedicine. We aimed to investigate if the uptake in telemedicine during pandemic was equitable across racial groups for patients with hematologic malignancies. Methods: Using the nationwide Flatiron Health electronic health record (EHR)-derived de-identified database we analyzed patients with diagnosis of acute myelogenous leukemia (AML), diffuse large B-cell lymphoma (DLBCL), follicular lymphoma (FL), mantle cell lymphoma (MCL), chronic lymphocytic leukemia (CLL) or multiple myeloma (MM). Patients were categorized into treatment types within lines of therapy: outpatient (oral therapy and outpatient infusions combined with oral therapy) vs. inpatient treatments (chemotherapy, cellular therapy). Monthly visit rates were calculated as the number of visits (telemedicine or in-person [in-clinic treatment administration, vitals, and/or labs]) per active patient per 30-day standardized month. We used time-series forecasting methods on pre-pandemic monthly visit rate data (March 2016 - February 2020) to estimate projected counterfactual monthly visit rates between March 2020 - February 2021.Telemedicine uptake was descriptively analyzed over time (t). Results: We included 18,924 active patients (2,394 Black and 16,530 White) and 884,504 visits (117,673 Black and 766,831 White). 4,053 AML, 3,468 diffuse large B cell lymphoma, 1,943 follicular lymphoma, 2,151 mantle cell lymphoma, 5,926 chronic lymphocytic leukemia and 7,752 myeloma patients. Black patients had no significant reductions in in-person visit rates throughout the pandemic period compared to the projected rates. Conversely, White patients experienced an 18% (95% PI 9.9% - 25%) lower rate of in-person visits for outpatient therapy during the early pandemic (March - May 2020) (actual monthly visit rate 1.61; projected visit rate 2.0 [95% CI 1.8-2.2]). Telemedicine uptake was significantly higher for White patients compared with Black patients for all diseases and treatment categories between March 2020-February 2021 (t = 9.5, p < 0.01), AML inpatient (t = 2.4, p = 0.04), MM outpatient (Figure 3C) (t = 6.0, p < 0.01) and MM inpatient treatment categories (Figure 3D) (t = 2.3, p = 0.04). Conclusions: White patients had significantly higher telemedicine uptake compared with Black patients for all treatment categories. These findings challenge healthcare systems to direct efforts toward reducing the gap in healthcare access.

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“…In a racially diverse study of US older adults, 76% reported minimal video-based socializing; access to and discomfort with technology were described as a key barrier to coping, maintaining social connection, and accessing health care during the pandemic [ 26 ]. There are other factors that are associated with nonuse of digital technologies that we did not evaluate, including cognitive impairment, frailty, vision or hearing impairments, and non-English/French speaking ability [ 27 , 28 ]. The unique needs and barriers of these population subgroups warrant thorough investigation and consideration when designing interventions, programs, and services.…”

Section: Discussionmentioning

confidence: 99%

The Factors Associated With Nonuse of Social Media or Video Communications to Connect With Friends and Family During the COVID-19 Pandemic in Older Adults: Web-Based Survey Study

Savage¹,

Nicolo

Wu³

et al. 2022

JMIR Aging

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Background Digital technologies have enabled social connection during prolonged periods of physical distancing and travel restrictions throughout the COVID-19 pandemic. These solutions may exclude older adults, who are at higher risk for social isolation, loneliness, and severe outcomes if infected with SARS-CoV-2. Objective This study investigated factors associated with nonuse of social media or video communications to connect with friends and family among older adults during the pandemic’s first wave. Methods A web-based, cross-sectional survey was administered to members of a national retired educators’ organization based in Ontario, Canada, between May 6 and 19, 2020. Respondents (N=4879) were asked about their use of social networking websites or apps to communicate with friends and family, their internet connection and smartphone access, loneliness, and sociodemographic characteristics. Factors associated with nonuse were evaluated using multivariable logistic regression. A thematic analysis was performed on open-ended survey responses that described experiences with technology and virtual connection. Results Overall, 15.4% (751/4868) of respondents did not use social networking websites or apps. After adjustment, male gender (odds ratio [OR] 1.60, 95% CI 1.33-1.92), advanced age (OR 1.88, 95% CI 1.38-2.55), living alone (OR 1.68, 95% CI 1.39-2.02), poorer health (OR 1.33, 95% CI 1.04-1.71), and lower social support (OR 1.44, 95% CI 1.20-1.71) increased the odds of nonuse. The reliability of internet connection and access to a smartphone also predicted nonuse. Many respondents viewed these technologies as beneficial, especially for maintaining pre–COVID-19 social contacts and routines, despite preferences for in-person connection. Conclusions Several factors including advanced age, living alone, and low social support increased the odds of nonuse of social media in older adults to communicate with friends and family during COVID-19’s first wave. Our findings identified socially vulnerable subgroups who may benefit from intervention (eg, improved access, digital literacy, and telephone outreach) to improve social connection.

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Telemedicine disparities during COVID‐19: Provider offering and individual technology availability

Cited by 11 publications

References 4 publications

Availability and use of telehealth services among patients with ADRD enrolled in traditional Medicare vs. Medicare advantage during the COVID-19 pandemic

Availability and use of telehealth services among patients with ADRD enrolled in traditional Medicare vs. Medicare advantage during the COVID-19 pandemic

Racial Disparities in Telemedicine Uptake during the COVID-19 Pandemic among Patients with Hematologic Malignancies in the United States

The Factors Associated With Nonuse of Social Media or Video Communications to Connect With Friends and Family During the COVID-19 Pandemic in Older Adults: Web-Based Survey Study

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