CHICAGO: The COVID-19 pandemic has fundamentally changed the health care delivery landscape and shifted the ways in which patients access health care. Digital literacy, access to technology, and the ability to effectively communicate with providers virtually have become critical indicators of social determinants of health. Now, to add to our understanding, Boston-area researchers have investigated demographic disparities in the use of virtual consultation compared with in-person surgical consultation after the initial COVID-19 Public Health Emergency. Their findings appear in an article—among the first of its kind—published online by the Journal of the American College of Surgeons.
“The surge in telemedicine has focused attention on the digital divide and highlighted the limited ability of vulnerable populations to access and use telemedicine,” said lead author Gezzer Ortega, MD, MPH, lead faculty for Research and Innovation for Equitable Surgical Care, Center for Surgery and Public Health, and adjunct faculty, Patient-Reported Outcomes, Value and Experience Center at Brigham and Women’s Hospital, Boston, Massachusetts.
While the number of Americans with access to high-speed internet is growing, more than 21 million Americans still lack broadband internet access.1 Additionally, internet capable device ownership remains disproportionately reduced among low-income and older Americans.2 Researchers aimed to identify disparities between in-person and telemedicine surgical consultation within their own hospital system.
Study details
The study was a retrospective analysis within the division of general and gastrointestinal surgery at an academic medical center occurring between March 24 and June 23, 2020 (Phase I), and June 24 through December 31, 2020 (Phase II).
The Phase I and Phase II dates were selected according to Massachusetts state policies that affected the delivery of non-emergent surgical services, including outpatient consultation. On March 24, 2020, an emergency order was issued by the Massachusetts state governor, which mandated closure of all businesses and organizations not providing COVID-19 essential services and initiated a stay-at-home advisory. On June 24, 2020, the Massachusetts Department of Public Health enacted reopening guidelines authorizing the resumption of non-essential elective surgical procedures and in-person consultation.
The analysis involved 4,908 patients across both phases. During Phase I, 347 in-person and 638 virtual visits were completed. There were no significant differences in virtual compared to in-person visit use across demographic or insurance groups. Among patients utilizing virtual visits, Latinx and Hispanic patients were less likely to have video compared with audio-only visits than white patients.
During Phase II, 2,922 in-person and 1,001 virtual visits were completed. No significant differences were observed across insurance types; however, Black patients were more likely to have virtual visits than white patients. Among patients utilizing virtual visits, race or ethnicity and insurance type were not significant predictors of video use.
Key findings
- During Phase I, two-thirds of patients attended surgical consultation via telemedicine visits. The majority of these patients were white, and there were no statistically significant differences in virtual visit use across racial or ethnic groups.
- Latinx and Hispanic patients were less likely to have video visits than white patients.
- During Phase II, in-person visits increased. White patients remained the majority of patients being seen by virtual visit, though notably, Black patients were 50 percent more likely to have virtual visits than white patients.
- Older age, lower education level, and non-English as a primary language were associated with decreased video use.
The study is limited by missing race, ethnicity, and education level data, which ultimately reduced the sample size of the overall study. “Notably, our institution implemented systematic efforts to collect more patient demographic data early in the pandemic, which resulted in decreased proportions of missing race, ethnicity, and education level data during Phase II,” said Dr. Ortega.
