JMIR Publications

ABSTRACT

Background:

Telemedicine has become widely utilized as a novel way to provide outpatient care during the coronavirus disease (COVID-19) pandemic, but data about telemedicine use in primary care remains limited.

Objective:

Our study aims to further characterize sociodemographic differences in primary care utilization via telehealth compared to in-person office visits before and during the COVID-19 pandemic, and determine if these disparities changed throughout 2020.

Methods:

We conducted a retrospective cohort study in a large academic center with 46 primary care practices from April-December 2019 and April-December 2020. We queried and compared billed outpatient encounters in General Internal Medicine and Family Medicine via binary logic mixed effects regression model and estimated odds ratios and 95% confidence intervals (OR, 95% CI). We used sex, race, and ethnicity of the patient attending each encounter as fixed effects.

Results:

A total of 81,822 encounters in the pre-COVID-19 timeframe and 47,994 encounters in the intra-COVID-19 timeframe were analyzed. Encounters with the following patients were less likely to be via telehealth compared to in-person office visits- patients who self-identified as Asian (OR 0.74, 95% CI 0.63-0.86) and Nepali (OR 0.37, 95% CI 0.19-0.72), patients covered by Medicare (OR 0.77, 95% CI 0.68-0.88), and patients living in zip codes with high supplemental nutritional assistance usage (OR 0.84, 95% CI 0.71-0.99). Many of these disparities persisted throughout the year.

Conclusions:

Telehealth was not utilized equally by all patients within primary care throughout the first year of the COVID-19 pandemic. Institutions should continue to monitor disparities in telehealth access, and advocate for policy changes that may improve equity.