Pain Care Disparities and the Use of Virtual Care Among Racial-Ethnic Minority Groups During COVID-19.
Pain Care Disparities and the Use of Virtual Care Among Racial-Ethnic Minority Groups During COVID-19.
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COVID-19 期间少数族裔群体的疼痛护理差异和虚拟护理的使用。
DOI：
10.1007/s11606-023-08473-0
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发表时间：
2024
影响因子：
5.7
通讯作者：
Chen,JessicaA
中科院分区：
文献类型：
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作者：
Javier,SarahJ;Carey,EvanP;Gunzburger,Elise;Chen,Huang-YuanP;Zeliadt,StevenB;Williams,EmilyC;Chen,JessicaA
背景与目的covid -19导致对虚拟模式的空前依赖，以维持慢性疼痛患者的护理连续性。我们研究了COVID-19期间少数民族群体的虚拟专科疼痛护理是否存在差异。设计和参与者：这是一项回顾性国家队列研究，有两个对照组：在COVID-19之前立即就诊的慢性疼痛初级保健患者（3/1/19-2/29/20）（N= 1,649,053）和一年前就诊的患者（3/1/18-2/28-19；N= 1,536,954）。我们评估了远程医疗（电话或视频）专业疼痛护理、现场护理专业疼痛护理和任何专业疼痛护理在队列纳入后6个月的使用情况。我们使用准泊松回归来检验患者种族和民族与接受治疗之间的关系。关键结果在新冠肺炎之前，在远程医疗使用方面存在黑人-白人（RR = 0.64, 95% CI[0.62, 0.67]）和亚洲-白人（RR = 0.63, 95% CI[0.54, 0.75]）差异，在新冠肺炎期间，这些差异有所减小（黑人-白人：RR = 0.75, 95% CI[0.73, 0.77]，亚洲-白人：RR = 0.81, 95% CI[0.74, 0.89]），但没有消失。在COVID-19早期，美国印第安人/阿拉斯加原住民个体使用远程医疗的频率低于白人个体（RR = 0.98, 95% CI[0.85, 1.13]至RR = 0.87, 95% CI[0.79, 0.96]）。西班牙裔/拉丁裔个体在COVID-19之前使用远程医疗的可能性低于非西班牙裔/拉丁裔个体，但在COVID-19早期使用远程医疗的可能性更高（RR = 0.70, 95% CI[0.66, 0.75]至RR = 1.06, 95% CI[1.02, 1.09]）。虚拟疼痛护理的差异发生在大流行早期专科疼痛护理总体减少的背景下（从covid前到covid时代，总共减少了n= 17,481次专科护理），包括黑人（RR = 0.81, 95% CI[0.80, 0.83]至RR = 0.79, 95% CI[0.77, 0.80]）和亚洲人（RR = 0.91, 95% CI[0.86, 0.97]至RR = 0.88, 95% CI[0.82, 0.94]）的任何VA专科疼痛护理差异增加。结论在COVID-19大流行的早期阶段，虚拟专科疼痛护理的差异比大流行前小，但尽管远程医疗快速增长，但并未完全消失。有针对性的努力，以增加获得专业疼痛护理需要集中在少数族裔群体。
Background and ObjectiveCOVID-19 led to an unprecedented reliance on virtual modalities to maintain care continuity for patients living with chronic pain. We examined whether there were disparities in virtual specialty pain care for racial-ethnic minority groups during COVID-19.Design and ParticipantsThis was a retrospective national cohort study with two comparison groups: primary care patients with chronic pain seen immediately prior to COVID-19 (3/1/19–2/29/20) (N= 1,649,053) and a cohort of patients seen in the year prior (3/1/18–2/28–19;n= 1,536,954).Main MeasuresWe assessed use of telehealth (telephone or video) specialty pain care, in-person care specialty pain care, and any specialty pain care for both groups at 6 months following cohort inclusion. We used quasi-Poisson regressions to test associations between patient race and ethnicity and receipt of care.Key ResultsPrior to COVID-19, there were Black-White (RR = 0.64, 95% CI [0.62, 0.67]) and Asian-White (RR = 0.63, 95% CI [0.54, 0.75]) disparities in telehealth use, and these lessened during COVID-19 (Black-White: RR = 0.75, 95% CI [0.73, 0.77], Asian-White: RR = 0.81, 95% CI [0.74, 0.89]) but did not disappear. Individuals identifying as American Indian/Alaska Native used telehealth less than White individuals during early COVID-19 (RR = 0.98, 95% CI [0.85, 1.13] to RR = 0.87, 95% CI [0.79, 0.96]). Hispanic/Latinx individuals were less likely than non-Hispanic/Latinx individuals to use telehealth prior to COVID-19 but more likely during early COVID-19 (RR = 0.70, 95% CI [0.66, 0.75] to RR = 1.06, 95% CI [1.02, 1.09]). Disparities in virtual pain care occurred over the backdrop of overall decreased specialty pain care during the early phase of the pandemic (raw decrease ofn= 17,481 specialty care encounters overall from pre-COVID to COVID-era), including increased disparities in any VA specialty pain care for Black (RR = 0.81, 95% CI [0.80, 0.83] to RR = 0.79, 95% CI [0.77, 0.80]) and Asian (RR = 0.91, 95% CI [0.86, 0.97] to RR = 0.88, 95% CI [0.82, 0.94]) individuals.ConclusionsDisparities in virtual specialty pain care were smaller during the early phases of the COVID-19 pandemic than prior to the pandemic but did not disappear entirely, despite the rapid growth in telehealth. Targeted efforts to increase access to specialty pain care need to be concentrated among racial-ethnic minority groups.