Key result
Age ≥80 years is linked to ~76% lower odds of video versus phone telemedicine.
Why the study?
It was unknown if early sociodemographic disparities in telemedicine use persisted during the COVID-19 pandemic and whether they were associated with changes in the population of patients accessing cardiovascular care.
Do sociodemographic disparities affect the mode of ambulatory cardiovascular care and telemedicine delivery during the COVID-19 pandemic?
Observational (n=113,888)
Yes
Do sociodemographic disparities affect the mode of ambulatory cardiovascular care and telemedicine delivery during the COVID-19 pandemic?
Vulnerable sociodemographic groups faced significant barriers to accessing video-based telemedicine for cardiovascular care during the pandemic, underscoring the need for inclusive digital health workflows.
Answers are grounded in this paper and cite their sources.
May limit equitable cardiovascular care for older, Black, and limited-English patients; leaves open whether interventions can mitigate telemedicine disparities.
BACKGROUND: The COVID-19 pandemic accelerated adoption of telemedicine in cardiology clinics. Early in the pandemic, there were sociodemographic disparities in telemedicine use. It is unknown if these disparities persisted and whether they were associated with changes in the population of patients accessing care. METHODS: We examined all adult cardiology visits at an academic and an affiliated community practice in Northern California from March 2019 to February 2020 (pre-COVID) and March 2020 to February 2021 (COVID). We compared patient sociodemographic characteristics between these periods. We used logistic regression to assess the association of patient/visit characteristics with visit modality (in-person vs telemedicine and video- vs phone-based telemedicine) during the COVID period. RESULTS: There were 54,948 pre-COVID and 58,940 COVID visits. Telemedicine use increased from <1% to 70.7% of visits (49.7% video, 21.0% phone) during the COVID period. Patient sociodemographic characteristics were similar during both periods. In adjusted analyses, visits for patients from some sociodemographic groups were less likely to be delivered by telemedicine, and when delivered by telemedicine, were less likely to be delivered by video versus phone. The observed disparities in the use of video-based telemedicine were greatest for patients aged ≥80 years (vs age <60, OR 0.24, 95% CI 0.21, 0.28), Black patients (vs non-Hispanic White, OR 0.64, 95% CI 0.56, 0.74), patients with limited English proficiency (vs English proficient, OR 0.52, 95% CI 0.46-0.59), and those on Medicaid (vs privately insured, OR 0.47, 95% CI 0.41-0.54). CONCLUSIONS: During the first year of the pandemic, the sociodemographic characteristics of patients receiving cardiovascular care remained stable, but the modality of care diverged across groups. There were differences in the use of telemedicine vs in-person care and most notably in the use of video- vs phone-based telemedicine. Future studies should examine barriers and outcomes in digital healthcare access across diverse patient groups.
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Osmanlliu et al. (2023) conducted an observational in Cardiovascular ambulatory care (n=113,888). Sociodemographic risk factors (older age, Black or Hispanic race, limited English proficiency, Medicaid insurance) vs. Reference sociodemographic groups (younger age, non-Hispanic White race, English proficiency, private insurance) was evaluated on Likelihood of a telemedicine visit being delivered by video versus phone for patients aged ≥80 years compared to <60 years during the COVID period (OR 0.24, 95% CI 0.21-0.28). During the first year of the COVID-19 pandemic, patients aged ≥80 years, Black patients, and those with limited English proficiency had significantly lower odds of receiving video-based rather than phone-based telemedicine (e.g., OR 0.24 for age ≥80 vs <60).
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