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Patient Characteristics Associated With Telemedicine Access for Primary and Specialty Ambulatory Care During the COVID-19 Pandemic

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To identify the key insights or developments described in this article
1 Credit CME
Key Points

Question  What sociodemographic factors are associated with higher use of telemedicine and the use of video (vs telephone) for telemedicine visits for ambulatory care during the coronavirus disease 2019 (COVID-19) pandemic?

Findings  In this cohort study of 148 402 patients scheduled for primary care and medical specialty ambulatory telemedicine visits at a large academic health system during the early phase of the COVID-19 pandemic, older age, Asian race, non-English language as the patient’s preferred language, and Medicaid were independently associated with fewer completed telemedicine visits. Older age, female sex, Black race, Latinx ethnicity, and lower household income were associated with lower use of video for telemedicine care.

Meaning  This study identified racial/ethnic, sex, age, language, and socioeconomic differences in accessing telemedicine for primary care and specialty ambulatory care; if not addressed, these differences may compound existing inequities in care among vulnerable populations.

Abstract

Importance  The coronavirus disease 2019 (COVID-19) pandemic has required a shift in health care delivery platforms, necessitating a new reliance on telemedicine.

Objective  To evaluate whether inequities are present in telemedicine use and video visit use for telemedicine visits during the COVID-19 pandemic.

Design, Setting, and Participants  In this cohort study, a retrospective medical record review was conducted from March 16 to May 11, 2020, of all patients scheduled for telemedicine visits in primary care and specialty ambulatory clinics at a large academic health system. Age, race/ethnicity, sex, language, median household income, and insurance type were all identified from the electronic medical record.

Main Outcomes and Measures  A successfully completed telemedicine visit and video (vs telephone) visit for a telemedicine encounter. Multivariable models were used to assess the association between sociodemographic factors, including sex, race/ethnicity, socioeconomic status, and language, and the use of telemedicine visits, as well as video use specifically.

Results  A total of 148 402 unique patients (86 055 women [58.0%]; mean [SD] age, 56.5 [17.7] years) had scheduled telemedicine visits during the study period; 80 780 patients (54.4%) completed visits. Of 78 539 patients with completed visits in which visit modality was specified, 35 824 (45.6%) were conducted via video, whereas 42 715 (54.4%) had telephone visits. In multivariable models, older age (adjusted odds ratio [aOR], 0.85 [95% CI, 0.83-0.88] for those aged 55-64 years; aOR, 0.75 [95% CI, 0.72-0.78] for those aged 65-74 years; aOR, 0.67 [95% CI, 0.64-0.70] for those aged ≥75 years), Asian race (aOR, 0.69 [95% CI, 0.66-0.73]), non-English language as the patient’s preferred language (aOR, 0.84 [95% CI, 0.78-0.90]), and Medicaid insurance (aOR, 0.93 [95% CI, 0.89-0.97]) were independently associated with fewer completed telemedicine visits. Older age (aOR, 0.79 [95% CI, 0.76-0.82] for those aged 55-64 years; aOR, 0.78 [95% CI, 0.74-0.83] for those aged 65-74 years; aOR, 0.49 [95% CI, 0.46-0.53] for those aged ≥75 years), female sex (aOR, 0.92 [95% CI, 0.90-0.95]), Black race (aOR, 0.65 [95% CI, 0.62-0.68]), Latinx ethnicity (aOR, 0.90 [95% CI, 0.83-0.97]), and lower household income (aOR, 0.57 [95% CI, 0.54-0.60] for income <$50 000; aOR, 0.89 [95% CI, 0.85-0.92], for $50 000-$100 000) were associated with less video use for telemedicine visits. These results were similar across medical specialties.

Conclusions and Relevance  In this cohort study of patients scheduled for primary care and medical specialty ambulatory telemedicine visits at a large academic health system during the early phase of the COVID-19 pandemic, older patients, Asian patients, and non–English-speaking patients had lower rates of telemedicine use, while older patients, female patients, Black, Latinx, and poorer patients had less video use. Inequities in accessing telemedicine care are present, which warrant further attention.

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Article Information

Accepted for Publication: November 8, 2020.

Published: December 29, 2020. doi:10.1001/jamanetworkopen.2020.31640

Correction: This article was corrected on February 19, 2021, to fix an error in the abstract results.

Open Access: This is an open access article distributed under the terms of the CC-BY License. © 2020 Eberly LA et al. JAMA Network Open.

Corresponding Author: Srinath Adusumalli, MD, MSc, Division of Cardiovascular Medicine, Department of Medicine, Hospital of the University of Pennsylvania, 3400 Civic Center Blvd, Perelman Center for Advanced Medicine South Pavilion, Room 11-139, Philadelphia, PA 19104 (srinath.adusumalli@pennmedicine.upenn.edu).

Author Contributions: Drs Eberly and Adusumalli had full access to all of the data in the study and take responsibility for the integrity of the data and the accuracy of the data analysis.

Concept and design: Eberly, Julien, Haynes, Nathan, Chokshi, Anastos-Wallen, Chaiyachati, Seigerman, Gitelman, Hanson, Deleener, Adusumalli.

Acquisition, analysis, or interpretation of data: Eberly, Kallan, Khatana, Snider, Eneanya, Takvorian, Ambrose, O’Quinn, Goldberg, Leri, Choi, Kolansky, Cappola, Ferrari, Hanson, Adusumalli.

Drafting of the manuscript: Eberly, Seigerman, Adusumalli.

Critical revision of the manuscript for important intellectual content: All authors.

Statistical analysis: Eberly, Kallan, Adusumalli.

Obtained funding: Adusumalli.

Administrative, technical, or material support: Haynes, Chokshi, Anastos-Wallen, Chaiyachati, Seigerman, Choi, Gitelman, Cappola, Adusumalli.

Supervision: Julien, Eneanya, Ambrose, Seigerman, Goldberg, Kolansky, Ferrari, Hanson, Deleener, Adusumalli.

Conflict of Interest Disclosures: Dr Eneanya reported receiving personal fees from Somatus outside the submitted work. Dr Chaiyachati reported receiving grants from Agency for Healthcare Research & Quality and Patient-Centered Outcomes Research Institute, and personal fees from Roundtrip Inc outside the submitted work. Dr Goldberg reported receiving grants from Respircaridia, and personal fees from Respircardia and Abbott outside the submitted work. No other disclosures were reported.

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