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Utilization gaps during the COVID-19 pandemic: racial and ethnic disparities in telemedicine uptake in federally qualified health center clinics.
Open accessAbstract
Background The Coronavirus Aid, Relief, and Economic Security (CARES) Act led to the rapid implementation of telemedicine across healthcare office settings. This innovation has the potential to improve healthcare use and ensure continuity of care. However, this delivery model could have an unintended consequence of worsening racial/ethnic disparities in healthcare utilization if adoption varies across sub-populations.Objective To examine associations between telemedicine use and race/ethnicity between 3/1/2020 and 11/30/2020, and the influence of other individual- and geographical-level factors on this relationship.Design Cohort study PARTICIPANTS: EMR data from 55 clinics in a FQHC network MAIN MEASURES: The dependent variable was visit type (in-person vs. telemedicine). Predictors of interest were patient race and ethnicity. To account for repeated visits within each patient nested within clinic, a three-level, mixed-effects, multivariable, logistic regression model was used. Subgroup analyses examined correlates of telemedicine use in African American and Hispanic cohorts, separately.Key results The analytic sample included 233,302 visits for 67,733 unique patients. African Americans (OR = 0.65, 95% CI: 0.61, 0.69), Asians (OR = 0.58, 95% CI: 0.52, 0.65), and American Indians / Alaska Natives and other Pacific Islanders (OR = 0.82, 95% CI: 0.70, 0.98) were significantly less likely to use telemedicine compared to Whites. Hispanics were also less likely to have a telemedicine visit (OR = 0.49, 95% CI: 0.47, 0.51) compared to non-Hispanics. Nonacute visits were more likely to be conducted via telemedicine. Distance to clinic exhibited a dose-response relationship such that patients who lived farthest from the clinics were most likely to have telemedicine visits. In the subgroup analyses to examine predictors of telemedicine use, the dose-response relationship between distance from clinic and telemedicine use persisted, with increasing distance associated with increasing likelihood of telemedicine use, in both African American and Hispanic cohorts. Nonacute visits were associated with telemedicine use in the Hispanic cohort, but not in the Black / African American cohort.Conclusion Racial/ethnic disparities in telemedicine use persisted among this cohort. However, telemedicine improved utilization for African Americans and Hispanics living farther away from the clinic.
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“and telehealth occurs less frequently.48,49”
From Mobile Health Intervention in Patients With Type 2 Diabetes: A Randomized Clinical Trial (2023) · cites this paper as [48]
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Metadata
- Authors
- Adepoju, O. E., Chae, M., Ojinnaka, C. O., Shetty, S., & Angelocci, T.
- Affiliations
- University of Houston (US)
- Arizona State University (US)
- Corresponding author
- Adepoju, Omolola E.
- Venue
- Journal of General Internal Medicine
- Published
- 2022-02-02
- Volume
- 37
- Issue
- 5
- Pages
- 1191-1197
- ISSN
- 0884-8734 (ISSN-L)
- 1525-1497
- PMC
- PMC8809627
- OpenAlex
- W4210314386
- Cited by
- 131
- References
- 24
- Citations by year
- 2026: 8 · 2025: 30 · 2024: 39 · 2023: 43 · 2022: 11
- FWCI
- 27.12
- Type
- journal article
- Language
- en
- Open access
- bronze
- doi.org
- Licence
- Locations
- Journal of General Internal Medicine (publishedVersion)
- PubMed Central (publishedVersion)
- PubMed (publishedVersion)
- Topics
- Health Sciences › Medicine › Public Health, Environmental and Occupational Health › Telemedicine and Telehealth Implementation
- Social Sciences › Health › Health disparities and outcomes
- Health Sciences › Medicine › Oncology › COVID-19 and healthcare impacts
- Keywords
- racial and ethnic disparities, COVID-19 pandemic, federally qualified health centers, CARES Act, African Americans, Hispanic patients, distance to clinic, continuity of care, telehealth adoption, American Indians and Alaska Natives, Asians, Pacific Islanders, non-Hispanic whites, rural health care
- MeSH terms
- COVID-19, Ethnicity, Humans, Telemedicine, Racial Groups, Healthcare Disparities, Pandemics
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