NEW YORK (Reuters Health) – Blacks used telemedicine for surgical consults more than whites during the second phase of the pandemic, suggesting they may have relied on virtual visits to access care, a study of demographic disparities at one large Boston hospital reveals.

Discrepancies in the use of video streaming during virtual visits were seen among other vulnerable populations, too.

“We still saw differences in use of video versus audio in the second phase, as patients with older age, lower educational level (high school or less), and non-English primary language used video less than audio,” Dr. Gezzer Ortega of Brigham and Women’s Hospital and Harvard Medical School told Reuters Health by email.

The finding that Blacks used telemedicine more than whites at his hospital, he said, “may reflect personal or cultural preferences, concerns about potential COVID-19 exposure during an in-person clinic visit, or privacy concerns in phase 2.”

“We also know that during that time, our institution and hospital made concerted efforts to increase access to populations that have been historically under-resourced,” he added. The efforts included “targeted enrollment of patients from these communities into the patient portal system, dissemination of internet-enabled devices, and integration of a secure video conferencing platform into the electronic health record system.”

As reported in the Journal of the American College of Surgeons, Dr. Ortega and colleagues investigated racial/ethnic and socioeconomic disparities in telemedicine compared with in-person surgical consultations during two phases of the COVID-19 pandemic: Phase I, Massachusetts Public Health Emergency (March 24-June 23, 2020) and Phase II, relaxation of restrictions on healthcare operations (June 24 through December 31, 2020).

The retrospective analysis included new visits within Brigham’s Division of General and Gastrointestinal Surgery using telemedicine/phone versus in-person contacts.

During Phase I, 347 in-person visits (median age, 56; 50%, women) and 638 virtual visits (median age, 52; 65%, women) occurred. Multivariable modeling demonstrated no significant between-group differences across racial/ethnic or insurance groups.

However, among virtual visits, Latinx patients were less likely than whites to have video compared with audio-only visits (odds ratio, 0.46). Insurance type, age, and education level were not significant predictors of video use.

During Phase II, 2,922 in-person and 1,001 virtual visits occurred. Multivariable modeling showed that Black patients were more likely to have virtual visits than whites (OR, 1.52). No significant differences were observed across insurance types. However, as Dr. Ortega noted, older age, lower education level, and having non-English primary language were significantly associated with decreased odds of video use.

Dr. Ortega said, “Clinicians should purposefully enroll under-resourced patients in telemedicine platforms, provide digital literary training when and where it is needed, and advocate for policies that expand reimbursement incentives for virtual care. These actions are a few among others that our clinicians can take to promote equitable access, public health, and preparedness during a crisis.”

Dr. Obinna Moneme, OhioHealth Service Line Chief – Virtual Health, commented on the study in an email to Reuters Health. “Historically, healthcare providers – and more importantly, the US Centers for Medicare and Medicaid Services and insurance companies – have viewed virtual health as a tool for rural communities. But the pandemic has really highlighted the obvious benefits for the underserved in urban and suburban areas.”

“The hope is that (the healthcare system) has provided education and access to these vulnerable populations to help recognize that virtual care will be with us long term, allowing patients to utilize it as a tool to receive appropriate care safely,” he said. “Our role as healthcare providers is to support these patients in this endeavor.”

“The data remind us to not make too many assumptions about who would prefer virtual care,” he noted. “In the big picture, we may have more success leveraging virtual in urban/suburban areas with the right focus and education.”

However, he added, “this is data from one institution, and may not be representative of what one would expect generally.”

SOURCE: Journal of the American College of Surgeons, online January 17, 2022.

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