Characteristics of telehealth users in NYC for COVID-related care during the coronavirus pandemic
Characteristics of telehealth users in NYC for COVID-related care during the coronavirus pandemic
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DOI：
10.1093/jamia/ocaa216
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发表时间：
2020-12-01
影响因子：
6.4
通讯作者：
Benn, Emma
中科院分区：
文献类型：
--
作者：
Weber, Ellerie;Miller, Sarah J.;Benn, Emma
目的：探讨在疫情高峰期寻求新冠肺炎相关症状治疗的纽约市患者中是否存在种族/民族差异。材料和方法：本研究使用美国危机的震中纽约市的一个大型卫生系统的数据来描述在疫情高峰期通过远程医疗、急诊室或办公室接触寻求冠状病毒相关治疗的患者的特征。使用多项Logistic回归方法，我们估计了患者特征与通过远程健康与急诊室或办公室就诊首次相遇的几率之间的关系的大小，然后使用回归参数估计来预测患者根据其特征使用不同相遇类型的概率。结果：包括种族/民族和年龄在内的人口统计学因素显著地预测了远程医疗的使用。与白人相比，黑人同时使用急诊室与远程医疗(OR：4.3，95%CI：4.0-4.6)和办公室就诊与远程医疗(OR：1.4，95%CI：1.3-1.5)的调整后几率更高。对于西班牙裔和白人，类似的OR分别为2.5(95%CI：2.3-2.7)和1.2(95%CI：1.1-1.3)。与任何年龄段的患者相比，65岁以上的患者使用急诊室或办公室就诊的几率明显高于远程医疗。结论：对新冠肺炎的回应涉及到远程医疗前所未有的扩张。虽然众所周知，美国老年人和少数族裔等人在数字鸿沟中处于不利地位，但很少有研究专门研究远程医疗方面的差异，也没有研究专门研究新冠肺炎期间的差异。需要对远程保健使用中的社会人口异质性进行更多的研究，以防止总体上可能进一步加剧健康差距。
Objective: To explore whether racial/ethnic differences in telehealth use existed during the peak pandemic period among NYC patients seeking care for COVID-19 related symptoms.Materials and Methods: This study used data from a large health system in NYC -the epicenter of the US crisis - to describe characteristics of patients seeking COVID-related care via telehealth, ER, or office encounters during the peak pandemic period. Using multinomial logistic regression, we estimated the magnitude of the relationship between patient characteristics and the odds of having a first encounter via telehealth versus ER or office visit, and then used regression parameter estimates to predict patients' probabilities of using different encounter types given their characteristics.Results: Demographic factors, including race/ethnicity and age, were significantly predictive of telehealth use. As compared to Whites, Blacks had higher adjusted odds of using both the ER versus telehealth (OR: 4.3, 95% CI: 4.0-4.6) and office visits versus telehealth (OR: 1.4, 95% CI: 1.3-1.5). For Hispanics versus Whites, the analogous ORs were 2.5 (95% CI: 2.3-2.7) and 1.2 (95% CI: 1.1-1.3). Compared to any age groups, patients 65+ had significantly higher odds of using either ER or office visits versus telehealth.Conclusions: The response to COVID-19 has involved an unprecedented expansion in telehealth. While older Americans and minority populations among others are known to be disadvantaged by the digital divide, few studies have examined disparities in telehealth specifically, and none during COVID-19. Additional research into sociodemographic heterogeneity in telehealth use is needed to prevent potentially further exacerbating health disparities overall.