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Cited by 740Telemedicine and Telehealth ImplementationCOVID-19 and healthcare impactsHealthcare Systems and Technology

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Patient characteristics associated with telemedicine access for primary and specialty ambulatory care during the COVID-19 pandemic.

Open access
Eberly, Lauren A., Kallan, Michael J., Julien, Howard M., Haynes, Norrisa, Khatana, Sameed Ahmed M., Nathan, Ashwin S., Snider, Christopher, Chokshi, Neel P., Eneanya, Nwamaka D., Takvorian, Samuel U., Anastos-Wallen, Rebecca, Chaiyachati, Krisda, Ambrose, Marietta, O’Quinn, Rupal, Seigerman, Matthew, Goldberg, Lee R., Leri, Damien, Choi, Katherine, Gitelman, Yevginiy, Kolansky, Daniel M., Cappola, Thomas P., Ferrari, Victor A., Hanson, C. William, Deleener, Mary Elizabeth, Adusumalli, Srinath·2020·JAMA Network Open
DOI 10.1001/jamanetworkopen.2020.31640PMC PMC7772717
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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 24 025 (56.9%) had a telephone visit. 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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Figure 1. Forest Plots Showing Adjusted Odds Ratios for Telemedicine Visit Completion
Figure 1. Forest Plots Showing Adjusted Odds Ratios for Telemedicine Visit CompletionCC BY · PubMed Central
Figure 2. Forest Plots Showing Adjusted Odds Ratios for Video Use for Telemedicine Visit
Figure 2. Forest Plots Showing Adjusted Odds Ratios for Video Use for Telemedicine VisitCC BY · PubMed Central

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Metadata

Authors
Eberly, L. A., Kallan, M. J., Julien, H. M., Haynes, N., Khatana, S. A. M., Nathan, A. S., Snider, C., Chokshi, N. P., Eneanya, N. D., Takvorian, S. U., Anastos-Wallen, R., Chaiyachati, K., Ambrose, M., O’Quinn, R., Seigerman, M., Goldberg, L. R., Leri, D., Choi, K., Gitelman, Y., Kolansky, D. M., Cappola, T. P., Ferrari, V. A., Hanson, C. W., Deleener, M. E., & Adusumalli, S.
Affiliations
  • Hospital of the University of Pennsylvania (US)
  • University of Pennsylvania (US)
  • University of Pennsylvania Health System (US)
  • Office of the Chief Medical Information Officer, University of Pennsylvania Health System, Philadelphia
Corresponding author
Adusumalli, Srinath
ORCID
Venue
JAMA Network Open
Publisher
American Medical Association (AMA)
Published
2020-12-29
Volume
3
Issue
12
Pages
e2031640
ISSN
2574-3805 (ISSN-L)
DOI
10.1001/jamanetworkopen.2020.31640
PMC
PMC7772717
OpenAlex
W3114602681
Cited by
740
References
19
Citations by year
2026: 54 · 2025: 79 · 2024: 117 · 2023: 170 · 2022: 202 · 2021: 115 · 2020: 1
FWCI
91.50
Type
journal article
Language
en
Open access
Licence
cc-by
Locations
  • JAMA Network Open (publishedVersion, cc-by)
  • Europe PMC (PubMed Central) (publishedVersion, cc-by)
  • PubMed Central (publishedVersion, cc-by)
  • PubMed (publishedVersion)
Funders
  • Agency for Healthcare Research and Quality (K12 HS026372)
  • National Heart, Lung, and Blood Institute (T32HL007843)
Topics
  • Health Sciences › Medicine › Public Health, Environmental and Occupational Health › Telemedicine and Telehealth Implementation
  • Health Sciences › Medicine › Oncology › COVID-19 and healthcare impacts
  • Health Sciences › Medicine › Public Health, Environmental and Occupational Health › Healthcare Systems and Technology
Keywords
telemedicine, video consultation, telephone visits, COVID-19 pandemic, health care access disparities, sociodemographic disparities, primary care, language barriers, older adults, racial and ethnic disparities, socioeconomic status, insurance type, telehealth utilization, academic health system
MeSH terms
COVID-19, SARS-CoV-2, Adult, Age Factors, Aged, Ambulatory Care, Asian, Black or African American, Female, Medicare, Health Services Accessibility, Hispanic or Latino, Humans, Income, Language, Male, Medicaid, Middle Aged, Primary Health Care, Sex Factors, Telephone, United States, Telemedicine, Videoconferencing, Healthcare Disparities, Secondary Care, Secondary Health Care, Tertiary Healthcare, Tertiary Health Care

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