JMIR Publications

ABSTRACT

Background:

Despite widespread interest in the use of telemedicine for ambulatory patient care during the COVID-19 pandemic, studies examining the adoption of ambulatory virtual visits during the pandemic by race, sex, age or payor are lacking. Moreover, there have been no evaluations to date of the impact of these demographic factors on the use of telephone versus video virtual visits. Such assessments are crucial to identify, understand, and address differences in care delivery across patient populations, particularly those that could affect access to or quality of care.

Objective:

To examine changes in ambulatory visit volume and type (in-person, video, telephone) by patient demographics during the COVID-19 pandemic at one urban academic medical center.

Methods:

We compared ambulatory visit volumes prior to and during the COVID-19 pandemic (2/2/20-5/31/20) with the corresponding weeks in 2019. Additionally, we examined patient demographics (age, sex, race, insurance type) overall and by visit type for visits in the 11 weeks following the COVID-19 national emergency declaration (3/15/20-5/31/20), compared with those in the corresponding weeks in 2019. Last, we examined differences in visit type by demographics using multivariate logistic regression.

Results:

For the COVID-19 study period, 61% of visits were virtual (video, 61%; telephone, 39%). Virtual (vs. in-person) visits were more likely among patients with Medicare (vs. commercial) insurance and less likely for men, patients aged 0-17, 65-74, or 75+ (compared to patients aged 18-45), and patients with Medicaid insurance. Among virtual visits, compared to telephone visits, video visits were more likely for patients aged 0-17 (vs. 18-45 years), but less likely for all other age groups, men, black (vs. white) patients, and patients with Medicare or Medicaid (vs. commercial) insurance.

Conclusions:

Virtual visits comprised the majority of ambulatory visits during the COVID-19 study period, of which a majority were by video. Sociodemographic differences existed in the use of virtual and video visits. To ensure equitable care delivery, sociodemographic differences in the use of virtual and video visits should inform further development of telemedicine programs and their reimbursement.