Socioeconomic factors associated with use of telehealth services in outpatient care settings during the COVID-19.

BACKGROUND: To examine potential changes and socioeconomic disparities in utilization of telemedicine in non-urgent outpatient care in Nevada since the COVID-19 pandemic. METHODS: This retrospective cross-sectional analysis of telemedicine used the first nine months of 2019 and 2020 electronic health record data from regular non-urgent outpatient care in a large healthcare provider in Nevada. The dependent variables were the use of telemedicine among all outpatient visits and using telemedicine more than once among those patients who did use telemedicine. The independent variables were race/ethnicity, insurance status, and language preference. RESULTS: Telemedicine services increased from virtually zero (16 visits out of 237,997 visits) in 2019 to 10.8% (24,159 visits out of 222,750 visits) in 2020. Asians (odds ratio [OR] = 0.85; 95% confidence interval [CI] = 0.85,0.94) and Latinos/Hispanics (OR = 0.89; 95% CI = 0.85, 0.94) were less likely to use telehealth; Spanish-speaking patients (OR = 0.68; 95% CI = 0.63, 0.73) and other non-English-speaking patients (OR = 0.93; 95% CI = 0.88, 0.97) were less likely to use telehealth; and both Medicare (OR = 0.94; 95% CI = 0.89, 0.99) and Medicaid patients (OR = 0.91; 95% CI = 0.87, 0.97) were less likely to use telehealth than their privately insured counterparts. Patients treated in pediatric (OR = 0.76; 95% CI = 0.60, 0.96) and specialty care (OR = 0.67; 95% CI = 0.65, 0.70) were less likely to use telemedicine as compared with patients who were treated in adult medicine. CONCLUSIONS: Racial/ethnic and linguistic factors were significantly associated with the utilization of telemedicine in non-urgent outpatient care during COVID-19, with a dramatic increase in telemedicine utilization during the onset of the pandemic. Reducing barriers related to socioeconomic factors can be improved via policy and program interventions.

Virtual Visits for Upper Respiratory Tract Infections in Adults Associated with Positive Outcome in a Cox Model.

There is no previous work on the relationship between a virtual visit for viral upper respiratory tract infection and improved outcome, even though there is data on the prevalence and other descriptors. We do not know if a virtual visit is an independent prognostic factor in community-based patients. With the exponential growth of this type of clinical visit, it is important for both clinical and planning considerations to evaluate this question. We analyzed a cohort of adult patients with newly diagnosed viral upper respiratory tract infection from a database of health plan patients seen virtually on telemedicine and in person at urgent cares in Las Vegas, Nevada between January 2014 and September 2014. Logistic regression, Kaplan-Meier survival analysis, and Cox proportional hazard model were used. Among the final 6,756 patients selected with upper respiratory tract infections (median age of 41.5), 6% had virtual visits, while the rest were seen in person at urgent cares. Patients who had virtual visits were more likely to be younger, but had no other firm demographic differences from those seen for upper respiratory tract infections in urgent care. Hazard ratio for 2-week follow-up (= failure), with no significant effect from covariates, was 0.55 (confidence interval 0.324-0.939, p < 0.05) in virtual patients. In this cohort of patients with upper respiratory tract infection, a virtual visit, compared to an in-person one at urgent care, is an independent prognostic factor for less follow-up within 2 weeks. Further research into other age groups, time periods, and different diagnoses using similar methodology is warranted.