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Study Shows How Telehealth Disparities Can Affect Quality of Care

During the COVID-19 pandemic, the use of telehealth, electronic patient portals, and other electronic modalities increased exponentially, enabling healthcare delivery while reducing patients’ and providers’ risk for SARS-CoV-2 infection. However, an analysis of the use of these services at an urban rheumatology center revealed significant disparities based on English-language proficiency, age, race, and income, according to data presented at ACR Convergence 2021, the annual meeting of the American College of Rheumatology.

“Given the telehealth expansion during COVID-19, there is concern that these disparities have widened and that new disparities have been created. How these disparities may be affecting rheumatology patients in the United States remains largely unknown,” said Jenna Thomason, MD, MPH, Acting Assistant Professor, Division of Rheumatology, University of Washington, Seattle, at a virtual press conference during the meeting.

To examine socioeconomic inequities in the use of telemedicine and electronic patient portals during the COVID-19 pandemic, Dr Thomason and colleagues analyzed the electronic health records of patients at the University of Washington Medical Center Rheumatology Clinic. All patients who completed visits before the COVID-19 pandemic between March 1, 2019, and February 28, 2020, and during the pandemic between April 1, 2020, and March 31, 2021, were included in the study.

The researchers analyzed age, sex, race, ethnicity, language, and payer data for all patients, as well as how far they lived from the hospital. The primary outcome measure was the completion of at least 1 telemedicine visit during the pandemic, with any use of the electronic patient portal from 2013 through April 1, 2020, established as the secondary outcome. Bivariate logistic regression analysis was used to calculate adjusted odds ratios for the primary and secondary outcomes.

During the prepandemic study period, a total of 1503 patients completed 3837 visits, all of which were conducted in person. During the pandemic, 1442 patients completed 3406 visits. Among these visits, 40.6% were in person, 29.1% were conducted by telephone, and 20.4% were via telemedicine. A total of 864 patients completed visits during both periods.

Study Results

During the pandemic, factors associated with telemedicine use included younger age, farther distance from the hospital, female sex, English language preference, white race identity, and having commercial insurance. 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 utilize telemedicine services. In addition, patients who preferred English as their language were 3.8 times more likely than those who preferred Spanish, and 3 times more likely than other non-English–preferring patients, to use telemedicine.

During the pandemic, electronic patient portal use was associated with patients being younger, female, non-Hispanic, white, English language-preferred, and having commercial insurance. 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 patient portal. English-preferring patients were 14.1 times more likely than Spanish-preferring patients, and 4.7 times more likely than 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,” Dr Thomason noted.

“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 said. “Rapid deployment and expansion of telehealth during the COVID-19 pandemic likely has improved access for some but widened preexisting 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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