Socioeconomic Disparities in Patient Use of Telehealth During the Coronavirus Disease 2019 Surge
Socioeconomic Disparities in Patient Use of Telehealth During the Coronavirus Disease 2019 Surge
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DOI：
10.1001/jamaoto.2020.5161
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发表时间：
2021-01-14
影响因子：
7.8
通讯作者：
Williams, Amy M.
中科院分区：
文献类型：
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作者：
Darrat, Ilaaf;Tam, Samantha;Williams, Amy M.
2019年冠状病毒病（COVID-19）大流行要求迅速过渡到远程医疗，目的是在遵守居家令的同时为患者提供医疗服务并支持临床医生。目的评估COVID-19大流行期间与患者参与远程医疗相关的人口统计学和社会经济因素。设计、环境和参与者本队列研究包括2020年3月17日至5月1日在位于COVID-19大流行早期热点的耳鼻喉头颈外科三级保健、学术、多亚专科、多地点实践中遇到的所有儿科和成人患者。会面包括完成同步的虚拟访问、电话访问和亲自访问以及未出现的访问。提取患者人口统计学特征、保险状况和2010年人口普查区块水平数据作为社会经济地位的代表。建立单变量和多变量logistic回归模型用于患者水平的比较。结果纳入1162例患者，其中女性604例（52.0%），中位年龄55岁（范围0 ~ 97岁），完成就诊990例；其中，437人（44.1%）完成了虚拟访问。多因素调整后，女性（优势比[OR]， 1.71; 95% CI, 1.11-2.63）和首选医疗机构保险的患者（优势比[OR]， 2.70; 95% CI, 1.40-5.20）比电话就诊更有可能完成虚拟就诊。年龄的增加（OR每年，0.98;95% CI, 0.98-0.99）和家庭收入中位数最低的四分位数（OR, 0.60; 95% CI, 0.42-0.86）与总体上完成虚拟就诊的几率较低相关。在人口普查区家庭收入中位数的第二（OR, 0.53; 95% CI, 0.28-0.99）和最低（OR, 0.33; 95% CI, 0.17-0.62）四分位数内的患者，以及有医疗补助、没有保险或其他公共保险的患者（OR, 0.47; 95% CI, 0.23-0.94）更有可能完成电话就诊。最后，已婚比例在较低的2个四分位数内（第三个四分位数的OR为0.49 [95% CI, 0.29-0.86]；最低四分位数的OR为0.39 [95% CI, 0.23-0.67]）与未赴约的可能性较高相关。结论和相关性这些研究结果表明，年龄、性别、家庭收入中位数、保险状况和婚姻状况与患者参与远程医疗有关。这些发现确定了弱势患者群体，他们可能不参与远程医疗，但在不断变化的医疗保健服务环境中仍然需要医疗保健。(c) 2021年美国医学协会。版权所有。
IMPORTANCE The coronavirus disease 2019 (COVID-19) pandemic required the rapid transition to telehealth with the aim of providing patients with medical access and supporting clinicians while abiding by the stay-at-home orders.OBJECTIVE To assess demographic and socioeconomic factors associated with patient participation in telehealth during the COVID-19 pandemic.DESIGN, SETTING, AND PARTICIPANTS This cohort study included all pediatric and adult patient encounters at the Department of Otolaryngology-Head & Neck Surgery in a tertiary care, academic, multisubspecialty, multisite practice located in an early hot spot for the COVID-19 pandemic from March 17 to May 1, 2020. Encounters included completed synchronous virtual, telephone, and in-person visits as well as visit no-shows.MAIN OUTCOMES AND MEASURES Patient demographic characteristics, insurance status, and 2010 Census block level data as a proxy for socioeconomic status were extracted. Univariate and multivariate logistic regression models were created for patient-level comparisons.RESULTS Of the 1162 patients (604 females [52.0%]; median age, 55 [range, 0-97] years) included, 990 completed visits; of these, 437 (44.1%) completed a virtual visit. After multivariate adjustment, females (odds ratio [OR], 1.71; 95% CI, 1.11-2.63) and patients with preferred provider organization insurance (OR, 2.70; 95% CI, 1.40-5.20) were more likely to complete a virtual visit compared with a telephone visit. Increasing age (OR per year, 0.98; 95% CI, 0.98-0.99) and being in the lowest median household income quartile (OR, 0.60; 95% CI, 0.42-0.86) were associated with lower odds of completing a virtual visit overall. Those patients within the second (OR, 0.53; 95% CI, 0.28-0.99) and lowest (OR, 0.33; 95% CI, 0.17-0.62) quartiles of median household income by census block and those with Medicaid, no insurance, or other public insurance (OR, 0.47; 95% CI, 0.23-0.94) were more likely to complete a telephone visit. Finally, being within the lower 2 quartiles of proportion being married (OR for third quartile, 0.49 [95% CI, 0.29-0.86]; OR for lowest quartile, 0.39 [95% CI, 0.23-0.67]) was associated with higher likelihood of a no-show visit.CONCLUSIONS AND RELEVANCE These findings suggest that age, sex, median household income, insurance status, and marital status are associated with patient participation in telehealth. These findings identify vulnerable patient populations who may not engage with telehealth, yet still require medical care in a changing health care delivery landscape. (c) 2021 American Medical Association. All rights reserved.