Equal availability of in-person, telemedicine visits key to avoid increasing healthcare disparities
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Patients who are Black, Latino, low socioeconomic status, older or use public insurance were less likely to engage in videoconferencing visits compared with in-person or telephone visits, according to a presenter at Digestive Disease Week.
“Healthcare stakeholders need to ensure equitable availability and reimbursement of in-person visits, telephone visits and video visits to evade disincentivizing certain visit modalities or risk widening existing health care disparities,” Nicolette Juliana Rodriguez, MD, from Brigham and Women's Hospital, department of medicine in Boston, told Healio Gastroenterology.
Rodriguez and colleagues performed a retrospective study of 6,111 complete GI telemedicine visits at a tertiary care center from April 1, 2020, to May 15, 2020. The center’s 3,589 in-person visits from the same period in 2019 served as control. Telemedicine included videoconferencing or telephone visits.
Variables investigators assessed included patient-reported race/ethnicity, age, sex, median income by zip code, insurance type and type of patient appointment. They used logistic regression to perform multivariable analyses.
Rodriguez said the proportion of new patient visits was lower in 2020. Patients who used videoconferencing were younger than patients who visited in person in 2019 (mean age, 46 years vs. 53.1 years; P < .0001). In addition, the videoconferencing group had a higher medium income by zip code ($75,850 vs. $72,292; P < .0001) and had a lower proportion of Black or Latino patients (6.96% vs. 16.94%; P < .0001) and public insurance users (5.01% vs. 9.31%; P < .0001).
The telephone group had a lower median income by zip code ($70,466 vs. $72,292; P = .016) and a higher proportion of Black or Latino patients (19.38% vs. 16.94%; P < .0001).
The multivariable analysis showed those less likely to complete video conferencing vs. in-person visits included Black (OR = 0.53; 95% CI, 0.36-0.79) and Latino (OR = 0.41; 95% CI, 0.28-0.6) patients, age over 60 years (OR = 0.56; 95% CI, 0.45-0.69), lowest quartile of income by zip code (OR = 0.71; 95% CI, 0.57-0.88), and public insurance patients (OR = 0.58; 95% CI, 0.47-0.72).
Among telemedicine patients in 2020, Black (OR = 3.05; 95% CI, 2.01-4.62) and Latino (OR = 3.31; 95% CI, 2.2-5) heritage, age over 60 years (OR = 1.95; 95% CI, 1.52-2.55), being in the lowest quartile of income by zip code (OR = 1.48; 95% CI, 1.14-1.93), and using public insuranace (OR = 1.74; 95% CI, 1.34-2.55) were independent predictors for engaging in telephone visits vs. videoconferencing visits.
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Rodriguez NJ, et al. Abstract 114. Presented at: Digestive Disease Week; May 21-24, 2021 (virtual meeting).
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