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The association between rurality, dual Medicare/Medicaid eligibility and chronic conditions with telehealth utilization: An analysis of 2019-2020 national Medicare claims.
Bogulski, Cari A; Pro, George; Acharya, Mahip; Ali, Mir M; Brown, Clare C; Hayes, Corey J; Eswaran, Hari.
Afiliação
  • Bogulski CA; Department of Biomedical Informatics, College of Medicine, University of Arkansas for Medical Sciences, Little Rock, AR, USA.
  • Pro G; Institute for Digital Health and Innovation, University of Arkansas for Medical Sciences, Little Rock, AR, USA.
  • Acharya M; Department of Health Behavior and Health Education, College of Public Health, University of Arkansas for Medical Sciences, Little Rock, AR, USA.
  • Ali MM; Institute for Digital Health and Innovation, University of Arkansas for Medical Sciences, Little Rock, AR, USA.
  • Brown CC; Institute for Digital Health and Innovation, University of Arkansas for Medical Sciences, Little Rock, AR, USA.
  • Hayes CJ; Department of Health Policy and Management, College of Public Health, University of Arkansas for Medical Sciences, Little Rock, AR, USA.
  • Eswaran H; Department of Biomedical Informatics, College of Medicine, University of Arkansas for Medical Sciences, Little Rock, AR, USA.
J Telemed Telecare ; : 1357633X241226741, 2024 Feb 05.
Article em En | MEDLINE | ID: mdl-38314738
ABSTRACT

INTRODUCTION:

Telehealth services have the potential to increase healthcare access among underserved populations, such as rural residents and racial/ethnic minority groups. The COVID-19 public health emergency led to unprecedented growth in telehealth utilization, but evidence suggests the growth has not been equitable across all patient populations. This study aimed to explore whether telehealth utilization and expansion changed equitably from 2019 to 2020 among sub-groups of Medicare beneficiaries.

METHODS:

We conducted an analysis of telehealth utilization among a 20% random sample of 2019-2020 Medicare beneficiaries on a national level. We fit multivariable logistic regression models and calculated average marginal effects (AME) to assess the association between demographic and clinical characteristics on telehealth utilization.

RESULTS:

We found telehealth utilization was less likely among non-Hispanic Black/African-American (2019 adjusted odds ratio [aOR] = 0.77, AME = -0.15; 2020 aOR = 0.85, AME = -3.50) and Hispanic (2019 aOR = 0.79, AME = -0.13; 2020 aOR = 0.87, AME = -2.89) beneficiaries, relative to non-Hispanic White beneficiaries in both 2019 and 2020, with larger disparities in 2020. Rural beneficiaries were more likely to utilize telehealth than urban beneficiaries in 2019 (aOR = 2.62, AME = 0.84), but less likely in 2020 (aOR = 0.57, AME = -14.47). In both years, dually eligible Medicare/Medicaid beneficiaries were more likely than non-dually eligible beneficiaries to utilize telehealth (2019 aOR = 4.75, AME = 0.84; 2020 aOR = 1.34, AME = 2.25). However, the effects of dual eligibility and rurality changed in both models as the number of chronic conditions increased.

DISCUSSION:

We found evidence of increasing disparities in telehealth utilization among several Medicare beneficiary sub-groups in 2020 relative to 2019, including individuals of minority race/ethnicity, rural residents, and dually eligible beneficiaries, with disparities increasing among individuals with more chronic conditions. Although telehealth has the potential to address health inequities, our findings suggest that many of the patients in greatest need of healthcare are least likely to utilize telehealth services.
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Texto completo: 1 Coleções: 01-internacional Base de dados: MEDLINE Tipo de estudo: Prognostic_studies / Risk_factors_studies Aspecto: Equity_inequality Idioma: En Revista: J Telemed Telecare Assunto da revista: INFORMATICA MEDICA / SERVICOS DE SAUDE Ano de publicação: 2024 Tipo de documento: Article País de afiliação: Estados Unidos País de publicação: Reino Unido

Texto completo: 1 Coleções: 01-internacional Base de dados: MEDLINE Tipo de estudo: Prognostic_studies / Risk_factors_studies Aspecto: Equity_inequality Idioma: En Revista: J Telemed Telecare Assunto da revista: INFORMATICA MEDICA / SERVICOS DE SAUDE Ano de publicação: 2024 Tipo de documento: Article País de afiliação: Estados Unidos País de publicação: Reino Unido