Socioeconomic and Demographic Disparities in the Utilization of Telemedicine for Ophthalmic Care during the COVID-19 Pan…
Ophthalmology. 2021 Jul 7:S0161-6420(21)00485-1. doi: 10.1016/j.ophtha.2021.07.003. Online ahead of print.
PURPOSE: To identify socioeconomic and demographic disparities in the utilization of telemedicine during the coronavirus disease 2019 (COVID-19) pandemic.
DESIGN: A cross-sectional study of completed clinical encounters in an academic ophthalmology center from March 1, 2020 through August 31, 2020.
PARTICIPANTS: A total of 5,023 patients comprising 8,116 ophthalmic clinical encounters were included.
METHODS: Medical charts were abstracted for patient demographic information. We utilized patients’ addresses to identify zipcode-level socioeconomic characteristics, which were drawn from the 2019 American Community Survey (ACS) 5-year estimates.
MAIN OUTCOME MEASURES: The completion of a synchronous video encounter, the completion of a telephone (audio-only) encounter in the absence of any video encounters, or the completion of in-person encounters only.
RESULTS: From March 1, 2020 to August 31, 2020 there were 8,116 total completed clinical encounters for 5,023 unique patients. Of these patients, 446 (8.9%) participated in a video encounter, 642 (12.8%) completed a telephone encounter and 3,935 (78.3%) attended clinical appointments in-person only. In adjusted analysis, patients who were Black/African American (odds ratio [OR], 0.65; 95% confidence interval [CI], 0.52-0.80; p<0.001) or Hispanic/Latino (OR, 0.65; 95% CI, 0.49-0.85; p=0.002) were significantly less likely to complete an appointment in a virtual setting (video or telephone). Older patients (OR, 0.99; 95% CI, 0.98-0.99; p<0.001), patients whose primary language was not English (OR, 0.49; 95% CI, 0.28-0.82; p=0.01), Black/African American patients (OR, 0.45; 95% CI, 0.32-0.62; p<0.001), and Hispanic/Latino patients (OR, 0.56; 95% CI, 0.37-0.83; p=0.005) were significantly less likely to complete a video encounter. Lastly, among patients completing any type of telemedicine encounter, older age, (OR, 1.02; 95% CI, 1.01-1.03; p<0.001), Medicare insurance (OR, 1.55; 95% CI, 1.11-2.17; p=0.01) and Black/African American ethnicity/race (OR, 1.97; 95% CI, 1.33-2.94; p<0.001) were associated with only utilizing phone visits.
CONCLUSIONS: Ethnic/racial minorities, older patients, and non-English speaking individuals were significantly less likely to complete a video telehealth encounter. In the context of expanding telemedicine usage in the United States, and the need to reduce the disparate impact of COVID-19 on minority populations, it will be increasingly important to identify barriers to telehealth utilization, as well as opportunities to improve access.