Infectious Disease

Differences in telemedicine use in rheumatology in relation to language, race, age, income

November 19, 2021

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Thomason J. Abstract 0615. Presented at: ACR Convergence 2021; 5-9 November 2021 (virtual meeting).

Disclosure:
Thomason does not report any relevant financial information. Please refer to the study for all relevant financial information from the other authors.

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A study of the use of telemedicine and electronic patient portals in a city rheumatology center found significant differences in English proficiency, age, race and income, according to data presented at ACR Convergence 2021.

“Outside of rheumatology, the differences in telemedicine are well documented”, Jenna Thomason, MD, MPH, from the University of Washington in Seattle told attendees at a virtual press conference. “Lower access or usage rates among people who are black, Latinx, older, non-English speaking, or poor. Similar differences were described for the access and use of the electronic patient portal. ”

“As health care moves towards ongoing digital care, clarifying and addressing the root causes of telemedicine disparities is essential to deliver equitable care to our patients,” Jenna Thomason, MD, MPH, told the press conference attendees . Source: Adobe Stock

“As telemedicine expanded during COVID-19, there is concern that these inequalities are growing and new inequalities have been created,” she added. “How these differences can affect rheumatism patients in the USA is still largely unknown.”

To investigate socio-economic inequalities in the use of telemedicine and electronic patient portals during the COVID-19 pandemic, Thomason and colleagues analyzed the electronic health records of patients at the University of Washington’s Rheumatology Clinic. All patients who completed visits prior to the COVID-19 pandemic between March 1, 2019 and February 28, 2020 and during the pandemic between April 1, 2020 and March 31, 2021 were included.

The researchers analyzed data on age, gender, race, ethnicity, language, and payer for all patients, as well as distance from the hospital. The primary endpoint was completing at least one telemedicine visit during the COVID-19 pandemic, with use of the electronic patient portal set as the secondary endpoint from 2013 to April 1. Thomason and colleagues used bivariate logistic regression analysis to calculate adjusted ORs for the primary and secondary endpoints.

During the pre-pandemic study period, a total of 1,503 patients completed 3,837 visits, all of which were personal. 1,442 patients received 3,406 visits during the pandemic. Of these visits, 40.6% were in person, 29.1% by telephone and 20.4% by telemedicine. A total of 864 patients completed the visits in both periods.

According to the researchers, younger age, greater distance from the hospital, female gender, English language preference, white race and commercial payers have been linked to telemedicine use during the pandemic. Patients who identified as white were 2.1 times more likely than black patients and 2.3 times more likely than Native American or Alaskan patients to use telemedicine.

Meanwhile, patients who preferred English as their language were 3.8 times more likely than those who preferred Spanish and 3 times more likely than other patients who did not prefer English to use telemedicine.

In patients observed during the COVID-19 pandemic, electronic portal use was associated with younger age, female gender, non-Hispanic or non-Latin ethnicity, white race, English-speaking preference, and commercial payer status. Patients who identified themselves as white used the portal 3.5 times more often than black patients and 3.7 times more often than patients with Native Americans or Alaskans. Those who preferred English used the portal 14.1 times more often than patients with a preference for Spanish and 4.7 times more often than other patients who do not prefer English.

“Not surprising as this is an English-only platform and there is a lack of support for translating messages,” said Thomason.

“Decreased use of video visits and patient portals among rheumatology patients is associated with non-English language preference, ethnic minority race, increasing age and indicators of low income,” she added. “The rapid adoption and expansion of telemedicine during the COVID-19 pandemic has likely improved access for some, but widened the disparities that already existed for others. As medical care is developing in the direction of ongoing digital care, clarifying and combating the causes of telemedicine disparities is of crucial importance for equitable care for our patients. “

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Annual meeting of the American College of Rheumatology

Annual meeting of the American College of Rheumatology

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