Disparities in Audio-only Telemedicine Use Among Medicare Beneficiaries During the Coronavirus Disease 2019 Pandemic.
Disparities in Audio-only Telemedicine Use Among Medicare Beneficiaries During the Coronavirus Disease 2019 Pandemic.
复制标题
DOI：
10.1097/mlr.0000000000001631
复制
发表时间：
2021-11-01
期刊：
影响因子：
3
通讯作者：
Chen J
中科院分区：
文献类型：
--
作者：
Benjenk I;Franzini L;Roby D;Chen J
根据紧急COVID-19规定，医疗保险为仅音频（电话）远程医疗访问提供与亲自访问相同的临时支付。该政策旨在将远程医疗扩展到没有配备摄像头的设备和宽带互联网的患者。然而，纯音频远程医疗的使用量很大。探讨大流行期间纯音频远程医疗的比率是否与患者获得技术或提供者行为有关。2020年夏季和秋季医疗保险当前受益人调查COVID-19补充的横断面分析，使用多变量逻辑模型并考虑复杂的调查设计。夏季调查的3，375名参与者和2020年秋季的2，633名参与者获得了远程医疗访问，以取代他们通常的护理提供者的预定亲自访问。我们比较了仅提供音频远程医疗的受益人与提供视频远程医疗或音频和视频的受益人。我们发现，在医疗保险受益人中，提供远程医疗以取代预定的面对面预约，大约35%的人只提供音频。65.8%的仅提供音频服务的受益人报告拥有智能手机/平板电脑和家庭互联网。在控制个人访问技术后，西班牙裔（AOR=2.09，p<0.001），双重资格（AOR=1.63，p=0.002），非主要英语（AOR=1.64，p<0.001）和非地铁受益人（AOR=1.71，p=0.003）更有可能在2020年7月至11月期间仅提供音频。这些研究结果表明，在大流行期间使用纯音频远程医疗与患者获得技术仅部分相关。政策制定者必须努力扩大为差异社区提供智能手机和宽带互联网的计划，并为提供商提供远程医疗基础设施。
Under emergency COVID-19 regulations, Medicare granted temporary payment parity with in-person visits for audio-only (telephone) telemedicine visits. This policy was designed to expand telemedicine to patients without camera-equipped devices and broadband internet. However, audio-only telemedicine use has been substantial. To explore whether the rate of audio-only telemedicine during the pandemic is related to patient access to technology or provider behavior. Cross-sectional analysis of the Summer and Fall 2020 Medicare Current Beneficiary Survey COVID-19 supplements, using multivariable logistic models and accounting for complex survey design. 3,375 participants in the summer survey and 2,633 participants in the fall 2020 were offered a telemedicine visit to replace a scheduled in-person visit by their usual care provider. We compared beneficiaries who were exclusively offered audio-only telemedicine to beneficiaries who were offered video telemedicine or both audio and video. We found that among Medicare beneficiaries who were offered telemedicine to replace a scheduled in-person appointment, approximately 35% were exclusively offered audio-only. 65.8% of beneficiaries exclusively offered audio-only reported having a smartphone/tablet and home internet. After controlling for personal access to technology, Hispanic (AOR=2.09, p<0.001), dually-eligible (AOR=1.63, p=0.002), non-primary English speaking (AOR=1.64, p<0.001), and non-metro beneficiaries (AOR=1.71, p=0.003) were more likely to be offered audio-only during July-November 2020. These findings suggest audio-only telemedicine use during the pandemic is only partially related to patient access to technology. Policymakers must work to both expand programs that provide smartphones and broadband internet to disparity communities and telemedicine infrastructure to providers.