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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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Traveling Towards Disease: Transportation Barriers to Health Care Access
Syed, S. T., Gerber, B. S., & Sharp, L. K. (2013) · Journal of Community Health · doi:10.1007/s10900-013-9681-1 · Cited by 1,987
Interactive telemedicine: effects on professional practice and health care outcomes
Flodgren, G., Rachas, A., Farmer, A. J., Inzitari, M., & Shepperd, S. (2015) · Cochrane Database of Systematic Reviews · doi:10.1002/14651858.cd002098.pub2 · Cited by 806
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Effect of the Affordable Care Act on Racial and Ethnic Disparities in Health Insurance Coverage
Buchmueller, T. C., Levinson, Z., Levy, H. G., & Wolfe, B. L. (2016) · American Journal of Public Health · doi:10.2105/ajph.2016.303155 · Cited by 390
The Digital Divide in Health-Related Technology Use: The Significance of Race/Ethnicity
Mitchell, U. A., Chebli, P., Ruggiero, L., & Muramatsu, N. (2018) · The Gerontologist · doi:10.1093/geront/gny138 · Cited by 320
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Disparities in the use of telehealth at the onset of the COVID-19 public health emergency
Pierce, R. P., & Stevermer, J. (2020) · Journal of Telemedicine and Telecare · doi:10.1177/1357633x20963893 · Cited by 263
Health Inequalities in the Use of Telehealth in the United States in the Lens of COVID-19
Jaffe, D. H., Lee, L., Huynh, S., & Haskell, T. P. (2020) · Population Health Management · doi:10.1089/pop.2020.0186 · Cited by 240
Prevalence and characteristics of telehealth utilization in the United States.
Fischer, S. H., Ray, K. N., Mehrotra, A., Bloom, E. L., & Uscher-Pines, L. (2020) · JAMA Network Open · doi:10.1001/jamanetworkopen.2020.22302 · Cited by 192
The ACA’s Impact On Racial And Ethnic Disparities In Health Insurance Coverage And Access To Care
Buchmueller, T. C., & Levy, H. G. (2020) · Health Affairs · doi:10.1377/hlthaff.2019.01394 · Cited by 187
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Multilevel Determinants of Digital Health Equity: A Literature Synthesis to Advance the Field
Lyles, C. R., Nguyen, O. K., Khoong, E. C., Aguilera, A., & Sarkar, U. (2022) · Annual Review of Public Health · doi:10.1146/annurev-publhealth-071521-023913 · Cited by 152
The Use of Digital Health Services Among Patients and Citizens Living at Home: Scoping Review
Rosenlund, M., Kinnunen, U., & Saranto, K. (2023) · Journal of Medical Internet Research · doi:10.2196/44711 · Cited by 83
Mobile Health Intervention in Patients With Type 2 Diabetes: A Randomized Clinical Trial
Gerber, B. S., Biggers, A., Tilton, J. J., Smith Marsh, D. E., Lane, R., Mihailescu, D., Lee, J., & Sharp, L. K. (2023) · JAMA Network Open · doi:10.1001/jamanetworkopen.2023.33629 · Cited by 61
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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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