Disparities in the use of telehealth in rheumatology related to language, race, age, income
November 19, 2021
2 minutes to read
Source / Disclosures
Thomason J. Abstract 0615. Presented at: ACR Convergence 2021; November 5-9, 2021 (virtual meeting).
Disclosures: Thomason does not report any relevant financial disclosure. Please see the study for relevant financial information from all other authors.
A study on the use of telemedicine and the electronic patient portal in an urban rheumatology center found significant disparities based on English proficiency, age, race and income, according to data presented at ACR Convergence 2021.
“Apart from rheumatology, disparities in telehealth are well documented”, Jenna Thomason, MD, MPH, from the University of Washington, Seattle, told attendees at a virtual press conference. “Lower access or use rates among black, Latin, older, non-English speaking or poor people. Similar disparities have been described for access and use of the electronic patient portal.
“Given the expansion of telehealth during COVID-19, there are concerns that these disparities have widened and new disparities have been created,” she added. “How these disparities may affect rheumatology patients in the United States remains largely unknown. “
To examine socio-economic inequalities in the use of telemedicine and electronic portals for patients during the COVID-19 pandemic, Thomason and his colleagues analyzed the electronic health records of patients at the Rheumatology Clinic of the University of Washington. All patients who made 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.
The researchers analyzed data on the age, sex, race, ethnicity, language and payer of 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 being defined as a secondary outcome. Thomason and colleagues used bivariate logistic regression analysis to calculate adjusted ORs for primary and secondary outcomes.
During the pre-pandemic study period, a total of 1,503 patients made 3,837 visits, all in person. During the pandemic, 1,442 patients made 3,406 visits. Of these visits, 40.6% were in person, 29.1% by phone and 20.4% by telemedicine. A total of 864 patients made visits during the two periods.
Younger age, greater distance from the hospital, female gender, preference for English, white race, and commercial payer were associated with the use of telemedicine during the pandemic, the researchers said. Patients who identified as white were 2.1 times more likely than black patients, and 2.3 times more likely than Native American or Alaska Native patients, to use telemedicine.
Meanwhile, patients who preferred English as a language were 3.8 times more likely than those who preferred Spanish, and three times more likely than other non-English patients, to use telemedicine.
Among patients seen during the COVID-19 pandemic, use of the electronic portal was associated with younger age, female, non-Hispanic or non-Latino ethnicity, white, preference for l English and the status of commercial payer. Patients who identified as white were 3.5 times more likely than black patients and 3.7 times more likely than Native American or Alaska Native patients to use the portal. Those who preferred English were 14.1 times more likely than patients who preferred Spanish, and 4.7 times more likely than other non-English patients, to use the portal.
“This is not surprising, given that this is an English-only platform and does not support message translation,” Thomason said.
“The decrease in video visits and patient portal use among rheumatology patients is associated with language preference other than English, minority race and ethnicity, increased age and health indicators. low income, ”she added. “The rapid deployment and expansion of telehealth during the COVID-19 pandemic likely improved access for some, but increased pre-existing disparities for others. As healthcare evolves into continuous digital healthcare delivery, clarifying and addressing the causes of disparities in telehealth is essential to providing equitable care to our patients. “