Sociodemographic Disparities in Ambulatory Pediatric Telemedicine Utilization During COVID-19.
Sociodemographic Disparities in Ambulatory Pediatric Telemedicine Utilization During COVID-19.
复制标题
COVID-19 期间流动儿科远程医疗利用的社会人口统计学差异。
DOI：
10.1089/tmj.2023.0005
复制
发表时间：
2024
期刊：
影响因子：
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通讯作者：
Jan,Sophia
中科院分区：
文献类型：
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作者：
Katzow,MichelleW;Steinway,Caren;Zuzarte,Andrea;Chen,Jack;Fishbein,Joanna;Jan,Sophia
目的：很少有研究调查 2019 年冠状病毒病大流行期间门诊儿科远程医疗利用的社会人口统计学差异。我们的目标是 (1) 评估 2020 年大流行前 6 周期间远程医疗就诊完成情况的差异，以及 (2) 确定这些差异是否与 2019 年所有就诊均亲自进行时存在的差异显着不同。 方法：我们使用广义线性混合模型，比较了 2020 年 3 月 10 日至 2020 年 4 月 18 日成功和不成功远程医疗就诊患者的社会人口特征。我们对 2019 年同期的亲自就诊进行了相同的分析。我们使用 2019-2020 年组合模型中的交互项测试了多年来的差异。结果：在计划的 3,639 次远程医疗就诊中，有 3,033 次（83.3%）成功。 2020 年，在调整年龄、性别、种族、保险类型、就诊时间、就诊专业、社会脆弱性指数和互联网接入后，与白人相比，黑人/非裔美国人种族与远程医疗就诊成功率较低显着相关（优势比 0.65 [95% 置信区间 0.49-0.87]）。 2019 年，白人以外的种族身份与亲自拜访成功的几率显着低于白人，公共保险与私人保险相比也是如此。在完整的 2019-2020 年模型中，亲自就诊（2019 年）的成功几率低于远程医疗就诊（2020 年），并且种族、保险类型或任何其他社会人口特征与年份都没有显着的交互作用。结论：在大流行早期，远程医疗利用方面存在明显的种族差异；然而，这些差异与 2019 年所有访问都是亲自进行的情况没有显着差异。此外，尽管远程医疗对不平等没有重大影响，但总体上可以改善获得医疗服务的机会。在各种就诊方式中，有必要努力消除门诊儿科医疗保健利用中的种族差异。
Objective:Few studies have examined sociodemographic disparities in ambulatory pediatric telemedicine utilization during the coronavirus disease 2019 pandemic. We aimed to (1) assess disparities in telemedicine visit completion during the first 6 weeks of the pandemic in 2020 and (2) determine if these disparities were significantly different from those present in 2019, when all visits occurred in person.Methods:We compared sociodemographic characteristics of patients with successful versus unsuccessful telemedicine visits from March 10, 2020 to April 18, 2020, using generalized linear mixed models. We performed the same analysis for in-person visits from the same period in 2019. We tested for differences across years using interaction terms in a combined 2019–2020 model.Results: Of 3,639 telemedicine visits scheduled, 3,033 (83.3%) were successful. In 2020, Black/African American race was significantly associated with lower odds of telemedicine visit success (odds ratio 0.65 [95% confidence interval 0.49–0.87]) compared with White race, after adjusting for age, gender, ethnicity, insurance type, visit timing, visit specialty, social vulnerability index, and internet access. In 2019, racial identity other than White was significantly associated with lower odds of in-person visit success than White, as was public insurance compared with private. In the full 2019–2020 model, in-person visits (2019) had lower odds of success than telemedicine visits (2020), and neither race, insurance type, nor any other sociodemographic characteristic had significant interactions with year.Conclusions: Racial disparities were evident in telemedicine utilization early in the pandemic; however, these disparities were not significantly different from those seen in 2019, when all visits were in person. Furthermore, telemedicine may improve access to care overall, despite having no significant impact on inequity. Efforts to eliminate racial disparities in ambulatory pediatric health care utilization are necessary across visit modalities.