Pre-existing Disparities and Potential Implications for the Rapid Expansion of Telemedicine in Response to the Coronavirus Disease 2019 Pandemic.
Pre-existing Disparities and Potential Implications for the Rapid Expansion of Telemedicine in Response to the Coronavirus Disease 2019 Pandemic.
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DOI：
10.1097/mlr.0000000000001585
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发表时间：
2021-08-01
期刊：
影响因子：
3
通讯作者：
Memtsoudis SG
中科院分区：
文献类型：
--
作者：
Poeran J;Cho LD;Wilson L;Zhong H;Mazumdar M;Liu J;Memtsoudis SG
人们担心，随着 COVID-19 大流行期间远程医疗的迅速实施，医疗保健获取方面现有的差距会进一步加剧。然而，目前缺乏有关远程医疗利用中预先存在的差异的数据。我们的目的是研究 1) 在 COVID-19 大流行之前，根据年龄、合并症负担、居住农村地区和家庭收入中位数划分的患者亚组的门诊远程医疗就诊率，以及 2) 相关诊断类别。回顾性队列研究来自 Truven MarketScan 数据库（2014-2018 年）的商业索赔数据，代表 n=846,461,609 次门诊就诊。我们根据年龄、合并症负担、居住农村地区和家庭收入中位数，研究了 COVID-19 大流行之前患者亚组的门诊远程医疗服务的特征和利用情况。在未调整和调整（回归）分析中评估差异。远程医疗总体使用率为 0.12%（n=1,018,092/846,461,609 门诊就诊次数），我们发现，随着时间的推移，COVID-19 之前的远程医疗使用差异变得更加明显，年龄较大、合并症较多、居住在农村地区以及家庭收入中位数较低的患者使用率较低（所有趋势和效果估计 p<0.001）。这些结果反映了远程医疗使用中预先存在的差异，对于监测远程医疗获取方面的潜在差异以及在 COVID-19 大流行期间远程医疗迅速扩张后的后续结果至关重要。
Concerns exist regarding exacerbation of existing disparities in healthcare access with the rapid implementation of telemedicine during the COVID-19 pandemic. However, data on pre-existing disparities in telemedicine utilization is currently lacking. We aimed to study 1) the prevalence of outpatient telemedicine visits before the COVID-19 pandemic by patient subgroups based on age, comorbidity burden, residence rurality, and median household income, and 2) associated diagnosis categories. Retrospective cohort study Commercial claims data from the Truven MarketScan database (2014-2018) representing n=846,461,609 outpatient visits. We studied characteristics and utilization of outpatient telemedicine services before the COVID-19 pandemic by patient subgroups based on age, comorbidity burden, residence rurality, and median household income. Disparities were assessed in unadjusted and adjusted (regression) analyses. With overall telemedicine uptake of 0.12% (n=1,018,092/846,461,609 outpatient visits) we found that pre-COVID-19 disparities in telemedicine use became more pronounced over time with lower use in patients who were older, had more comorbidities, were in rural areas, and had lower median household incomes (all trends and effect estimates p<0.001). These results contextualize pre-existing disparities in telemedicine use and are crucial in the monitoring of potential disparities in telemedicine access and subsequent outcomes after the rapid expansion of telemedicine during the COVID-19 pandemic.