Disparities in telehealth use for rheumatology linked to language, race, age, income
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A study of telemedicine and electronic patient portal use at an urban rheumatology center found significant disparities based on English-language proficiency, age, race and income, according to data presented at ACR Convergence 2021.
“Outside of rheumatology, disparities in telehealth are well documented,” Jenna Thomason, MD, MPH, of the University of Washington, in Seattle, told attendees at a virtual press conference. “Lower rates of access or utilization among people who are Black, Latinx, older, non-English speaking or poor. Similar disparities have been described for electronic patient portal access and use.”
“Given the telehealth expansion during COVID-19, there is concern that these disparities have widened and that new disparities have been created,” she added. “How these disparities may be affecting rheumatology patients in the U.S. remains largely unknown.”
To examine socioeconomic inequities in the use of telemedicine and electronic patient portals during the COVID-19 pandemic, Thomason and colleagues analyzed the electronic health records of patients at the University of Washington rheumatology clinic. All patients who completed visits prior to the COVID-19 pandemic between March 1, 2019, and Feb. 28, 2020, and during the pandemic between April 1, 2020, and March 31, 2021, were included.
The researchers analyzed age, sex, race, ethnicity, language and payor data for all patients, as well as how far they lived from the hospital. The primary outcome was the completion of at least one telemedicine visit during the COVID-19 pandemic, with any use of the electronic patient portal from 2013 through April 1 set as the secondary outcome. Thomason and colleagues used bivariate logistic regression analysis to calculate adjusted ORs for the primary and secondary outcomes.
During the pre-pandemic study period, a total of 1,503 patients completed 3,837 visits, all of which were conducted in-person. During the pandemic, 1,442 patients completed 3,406 visits. Among these visits, 40.6% were in-person, 29.1% were conducted over the telephone and 20.4% were via telemedicine. A total of 864 patients completed visits during both periods.
According to the researchers, younger age, farther distance from the hospital, female sex, English-language preference, white race and commercial payor were associated with telemedicine use during the pandemic. Patients who identified as white were 2.1 times more likely than Black patients, and 2.3 times more likely than American Indian or Alaska Native patients, to use telemedicine.
Meanwhile, patients who preferred English as their language were 3.8 times more likely than those who preferred Spanish, and three times more likely than other non-English-preferring patients, to use telemedicine.
Among patients seen during the COVID-19 pandemic, electronic portal use was associated with younger age, female sex, non-Hispanic or non-Latino ethnicity, white race, English-language preference and commercial payor status. Patients who identified as white were 3.5 times more likely than Black patients, and 3.7 times more likely than American Indian or Alaska Native patients, to use the portal. Those who preferred English were 14.1 times more likely than Spanish-preferring patients, and 4.7 times more likely other non-English-preferring patients, to use the portal.
“This is not surprising, given that this is an English-only platform, and it lacks support for message translation,” Thomason said.
“Decreased video visit and patient portal use among rheumatology patients is associated with non-English language preference, minority race and ethnicity, increasing age and indicators of low income,” she added. “Rapid deployment and expansion of telehealth during the COVID-19 pandemic likely has improved access for some but widened pre-existing disparities for others. As medical care evolves toward ongoing digital care delivery, clarifying and addressing causes of telehealth disparities is essential for delivering equitable care to our patients.”
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Thomason J. Abstract 0615. Presented at: ACR Convergence 2021; November 5-9, 2021 (virtual meeting).
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