Telehealth Disparities Remain Evident

Findings of a recent study suggested age, sex, median household income, insurance status, and marital status were associated with patient participation in telehealth.

Ilaaf Darrat, M.D., M.B.A., and colleagues assessed demographic and socioeconomic factors associated with patient participation in telehealth during the coronavirus disease 2019 (COVID-19) pandemic. They included patients receiving care in the otolaryngology department within an urban tertiary care center from March 17 to May 1, 2020. Patients included were had scheduled encounters with otolaryngologists or advanced practice clinicians.

The team used the electronic health record to extract demographic information, including the patient’s age, self-reported sex and race/ethnicity, and primary insurer. The investigators used U.S. 2010 Census block level data as a replacement for the patients’ socioeconomic status, which included education level, marital status, English-speaking households, employment level, and the proportion of households living above the federal poverty level in that patient’s zip code.

A patient was considered to have completed a virtual visit if at least one virtual visit was completed, regardless of status of any other visit types completed. The team defined virtual visits as a synchronous interaction through technology requiring audio and visual input.

Overall, of 1,162 patients seen, 990 (85.2%) completed in-person, virtual, or telephone visits. Of those patients, 44.1% completed virtual visits, 41.3% completed in-person visits, and 14.5% completed telephone visits.

Darrat and the investigators noted during the first week of the COVID-19 surge, in-person encounters were more common (74.1%), but at the surge continued, virtual encounters dramatically increased. By the fifth week of the pandemic, almost half of the encounters were virtual (49.2%). When the team analyzed patient characteristics by visit type, insurance type had a medium to large effect size, while all other characteristics except age has a small to medium effect size.

Females (OR, 1.71; 95% CI, 1.11-2.63) and patients with preferred provider organization insurance (OR, 2.7; 95% CI, 1.4-5.2) were more likely to complete a virtual visit compared with a telephone visit. Increasing age (OR per year, .98; 95% CI, .98-.99) was associated with lower odds of completing a virtual visit overall, along with being in the lowest median household income quartile (OR, .6; 95% CI, .42-.86).

Those more likely to complete a telephone visit were patients within the second (OR, .53; 95% CI, .28-.99) and lowest (OR, .33; 95% CI, .17-.62) quartiles of median household income by census block and those with Medicaid, no insurance, or other public insurance (OR, .47; 95% CI, .23-.94). Being within the lower two quartiles of proportion being married (OR for third quartile, .49 [95% CI, .29-.86]; OR for lowest quartile, .39 [95% CI, .23-.67]) was associated with higher likelihood of a no-show visit.

The findings may help clinicians focus on vulnerable patient populations who require access to specialty medical care.

The study, “Socioeconomic Disparities in Patient Use of Telehealth During the Coronavirus Disease 2019 Surge,” was published online in JAMA Otolaryngology-Head & Neck Surgery.