Demographic Disparity in Use of Telemedicine for Ambulatory General Surgical Consultation During the COVID-19 Pandemic: Analysis of the Initial Public Health Emergency and Second Phase Periods

• Main Authors: Bates, D.W (Author), Bergmark, R.W (Author), Cooper, Z. (Author), Eruchalu, C.N (Author), Nguyen, L.L (Author), Ortega, G. (Author), Smink, D.S (Author), Tavakkoli, A. (Author)
• Format: Article
• Language: English
• Published: NLM (Medline) 2022
• Subjects: adult; Adult; aged; Aged; ambulatory care; ambulatory surgery; Ambulatory Surgical Procedures; ancestry group; comparative study; Computer Literacy; COVID-19; epidemiology; ethnicity; Ethnicity; female; Female; general surgery; General Surgery; health care delivery; Health Services Accessibility; human; human computer interaction; Humans; insurance; Insurance Coverage; Logistic Models; male; Male; Massachusetts; middle aged; Middle Aged; Office Visits; pandemic; Pandemics; public health; Public Health; Racial Groups; Retrospective Studies; retrospective study; Socioeconomic Factors; socioeconomics; statistical model; telemedicine; Telemedicine; telephone; Telephone
• Online Access: View Fulltext in Publisher

 BACKGROUND: Surgical patients with limited digital literacy may experience reduced telemedicine access. We investigated racial/ethnic and socioeconomic disparities in telemedicine compared with in-person surgical consultation during the coronavirus disease 2019 (COVID-19) pandemic. STUDY DESIGN: Retrospective analysis of new visits within the Division of General & Gastrointestinal Surgery at an academic medical center occurring between March 24 through June 23, 2020 (Phase I, Massachusetts Public Health Emergency) and June 24 through December 31, 2020 (Phase II, relaxation of restrictions on healthcare operations) was performed. Visit modality (telemedicine/phone vs in-person) and demographic data were extracted. Bivariate analysis and multivariable logistic regression were performed to evaluate associations between patient characteristics and visit modality. RESULTS: During Phase I, 347 in-person and 638 virtual visits were completed. Multivariable modeling demonstrated no significant differences in virtual compared with in-person visit use across racial/ethnic or insurance groups. Among patients using virtual visits, Latinx patients were less likely to have video compared with audio-only visits than White patients (OR, 0.46; 95% CI 0.22-0.96). Black race and insurance type were not significant predictors of video use. During Phase II, 2,922 in-person and 1,001 virtual visits were completed. Multivariable modeling demonstrated that Black patients (OR, 1.52; 95% CI 1.12-2.06) were more likely to have virtual visits than White patients. No significant differences were observed across insurance types. Among patients using virtual visits, race/ethnicity and insurance type were not significant predictors of video use. CONCLUSION: Black patients used telemedicine platforms more often than White patients during the second phase of the COVID-19 pandemic. Virtual consultation may help increase access to surgical care among traditionally under-resourced populations. Copyright © 2022 by the American College of Surgeons. Published by Wolters Kluwer Health, Inc. All rights reserved.