Pain Care Disparities and the Use of Virtual Care Among Racial-Ethnic Minority Groups During COVID-19.
J Gen Intern Med
; 39(Suppl 1): 68-78, 2024 Feb.
Article
in En
| MEDLINE
| ID: mdl-38252245
ABSTRACT
BACKGROUND AND OBJECTIVE:
COVID-19 led to an unprecedented reliance on virtual modalities to maintain care continuity for patients living with chronic pain. We examined whether there were disparities in virtual specialty pain care for racial-ethnic minority groups during COVID-19. DESIGN ANDPARTICIPANTS:
This was a retrospective national cohort study with two comparison groups primary care patients with chronic pain seen immediately prior to COVID-19 (3/1/19-2/29/20) (N = 1,649,053) and a cohort of patients seen in the year prior (3/1/18-2/28-19; n = 1,536,954). MAINMEASURES:
We assessed use of telehealth (telephone or video) specialty pain care, in-person care specialty pain care, and any specialty pain care for both groups at 6 months following cohort inclusion. We used quasi-Poisson regressions to test associations between patient race and ethnicity and receipt of care. KEYRESULTS:
Prior to COVID-19, there were Black-White (RR = 0.64, 95% CI [0.62, 0.67]) and Asian-White (RR = 0.63, 95% CI [0.54, 0.75]) disparities in telehealth use, and these lessened during COVID-19 (Black-White RR = 0.75, 95% CI [0.73, 0.77], Asian-White RR = 0.81, 95% CI [0.74, 0.89]) but did not disappear. Individuals identifying as American Indian/Alaska Native used telehealth less than White individuals during early COVID-19 (RR = 0.98, 95% CI [0.85, 1.13] to RR = 0.87, 95% CI [0.79, 0.96]). Hispanic/Latinx individuals were less likely than non-Hispanic/Latinx individuals to use telehealth prior to COVID-19 but more likely during early COVID-19 (RR = 0.70, 95% CI [0.66, 0.75] to RR = 1.06, 95% CI [1.02, 1.09]). Disparities in virtual pain care occurred over the backdrop of overall decreased specialty pain care during the early phase of the pandemic (raw decrease of n = 17,481 specialty care encounters overall from pre-COVID to COVID-era), including increased disparities in any VA specialty pain care for Black (RR = 0.81, 95% CI [0.80, 0.83] to RR = 0.79, 95% CI [0.77, 0.80]) and Asian (RR = 0.91, 95% CI [0.86, 0.97] to RR = 0.88, 95% CI [0.82, 0.94]) individuals.CONCLUSIONS:
Disparities in virtual specialty pain care were smaller during the early phases of the COVID-19 pandemic than prior to the pandemic but did not disappear entirely, despite the rapid growth in telehealth. Targeted efforts to increase access to specialty pain care need to be concentrated among racial-ethnic minority groups.Key words
Full text:
1
Collection:
01-internacional
Database:
MEDLINE
Main subject:
Chronic Pain
/
COVID-19
Type of study:
Observational_studies
/
Risk_factors_studies
Limits:
Humans
Country/Region as subject:
America do norte
Language:
En
Journal:
J Gen Intern Med
Journal subject:
MEDICINA INTERNA
Year:
2024
Type:
Article
Affiliation country:
United States