JMIR Publications

ABSTRACT

Background:

Dramatic decreases in outpatient visits and sudden increases in telehealth visits were observed during the COVID-19 pandemic, but it was unclear whether these changes differed by patients’ demographics and socioeconomic status.

Objective:

To assess the impact of the pandemic on outpatient and telehealth visits by demographic characteristics and household income in a diverse population.

Methods:

We calculated weekly rates of outpatient and telehealth visits by age, sex, race/ethnicity, and neighborhood-level median household income among members of Kaiser Permanente Southern California (KPSC) during January 5, 2020-October 31, 2020, and the corresponding period in 2019. We estimated the change in visit rates during the early pandemic period (March 22-April 25, 2020) and the late pandemic period (October 4-October 31, 2020) from the pre-pandemic period (January 5-March 7, 2020) in Poisson regression models for each subgroup while adjusting for seasonality using 2019 data. We examined if the changes in visit rates differed by subgroups statistically by comparing their 95% confidence intervals.

Results:

Among 4.56 million KPSC members enrolled in January 2020, about 15% were aged ≥65 years, 52% were female, 39% were Hispanic, and 8% lived in an area of median household income less than $40,000. Increases in telehealth visits during the pandemic varied across subgroups, while decreases in outpatient visits were similar except for age. Among age groups, the 65 years and older population had the least increase in telehealth visits (236.6%; 95% confidence interval [CI], 228.8% to 244.5%): 4.9 per one person-year during the early pandemic period versus 1.5 per one person-year during the pre-pandemic period. During the same periods, across racial/ethnic groups, Hispanic individuals had the largest increase in telehealth visits (295.5%; 95% CI, 275.5% to 316.5%); across income levels, telehealth visits in the low-income group increased the most (313.5%; 95% CI, 294.8 to 333.1%). The rate of combined outpatient and telehealth visits in the Hispanic, Non-Hispanic Black, and low-income group returned to pre-pandemic levels by October 2020.

Conclusions:

The Hispanic group and the low-income group had the largest increase in telehealth utilization in responding to the COVID-19 pandemic. The use of virtual care potentially mitigated the impact of the pandemic on health care utilization in these vulnerable populations.