Identifying Inequities in Video and Audio Telehealth Services for Primary Care Encounters During COVID-19: Repeated Cross-Sectional, Observational Study.

Autor:	Buis LR; Department of Family Medicine, University of Michigan, Ann Arbor, MI, United States.; School of Information, University of Michigan, Ann Arbor, MI, United States., Brown LK; School of Information, University of Michigan, Ann Arbor, MI, United States., Plegue MA; Department of Pediatrics, University of Michigan, Ann Arbor, MI, United States., Kadri R; Department of Family Medicine, University of Michigan, Ann Arbor, MI, United States., Laurie AR; Department of Family Medicine, University of Michigan, Ann Arbor, MI, United States., Guetterman TC; Department of Family Medicine, University of Michigan, Ann Arbor, MI, United States., Vydiswaran VGV; School of Information, University of Michigan, Ann Arbor, MI, United States.; Department of Learning Health Sciences, University of Michigan Medical School, Ann Arbor, MI, United States., Li J; School of Information, University of Michigan, Ann Arbor, MI, United States., Veinot TC; School of Information, University of Michigan, Ann Arbor, MI, United States.; Department of Learning Health Sciences, University of Michigan Medical School, Ann Arbor, MI, United States.; Department of Health Behavior and Health Education, School of Public Health, University of Michigan, Ann Arbor, MI, United States.
Jazyk:	angličtina
Zdroj:	Journal of medical Internet research [J Med Internet Res] 2023 Sep 29; Vol. 25, pp. e49804. Date of Electronic Publication: 2023 Sep 29.
DOI:	10.2196/49804
Abstrakt:	Background: The COVID-19 pandemic resulted in rapid changes in how patient care was provided, particularly through the expansion of telehealth and audio-only phone-based care. Objective: The goal of this study was to evaluate inequities in video and audio-only care during various time points including the initial wave of the COVID-19 pandemic, later stages of the pandemic, and a historical control. We sought to understand the characteristics of care during this time for a variety of different groups of patients that may experience health care inequities. Methods: We conducted a retrospective analysis of electronic health record (EHR) data from encounters from 34 family medicine and internal medicine primary care clinics in a large, Midwestern health system, using a repeated cross-sectional, observational study design. These data included patient demographic data, as well as encounter, diagnosis, and procedure records. Data were obtained for all in-person and telehealth encounters (including audio-only phone-based care) that occurred during 3 separate time periods: an initial COVID-19 period (T2: March 16, 2020, to May 3, 2020), a later COVID-19 period (T3: May 4, 2020, to September 30, 2020), and a historical control period from the previous year (T1: March 16, 2019, to September 30, 2019). Primary analysis focused on the status of each encounter in terms of whether it was completed as scheduled, it was canceled, or the patient missed the appointment. A secondary analysis was performed to evaluate the likelihood of an encounter being completed based on visit modality (phone, video, in-person). Results: In total, there were 938,040 scheduled encounters during the 3 time periods, with 178,747 unique patients, that were included for analysis. Patients with completed encounters were more likely to be younger than 65 years old (71.8%-74.1%), be female (58.8%-61.8%), be White (75.6%-76.7%), and have no significant comorbidities (63.2%-66.8%) or disabilities (53.2%-61.1%) in all time periods than those who had only canceled or missed encounters. Effects on different subpopulations are discussed herein. Conclusions: Findings from this study demonstrate that primary care utilization across delivery modalities (in person, video, and phone) was not equivalent across all groups before and during the COVID-19 pandemic and different groups were differentially impacted at different points. Understanding how different groups of patients responded to these rapid changes and how health care inequities may have been affected is an important step in better understanding implementation strategies for digital solutions in the future. (©Lorraine R Buis, Lindsay K Brown, Melissa A Plegue, Reema Kadri, Anna R Laurie, Timothy C Guetterman, V G Vinod Vydiswaran, Jiazhao Li, Tiffany C Veinot. Originally published in the Journal of Medical Internet Research (https://www.jmir.org), 29.09.2023.)
Databáze:	MEDLINE
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