Some traditionally underserved groups have actually had greater telemedicine uptake for cardiology visits during the pandemic, researchers found in Los Angeles.
Asian, Black, and Hispanic individuals accounted for a similar proportion of in-person visits before and during the pandemic (28.6% and 26.5%), but that jumped to 30.4% of video-based cardiovascular care and 35.0% of telephone-based cardiology telehealth during the pandemic (P<0.001 for all comparisons).
Those with cardiovascular comorbidities also used telemedicine significantly more often, Neal Yuan, MD, of the Smidt Heart Institute at Cedars-Sinai Medical Center in Los Angeles, and colleagues reported in JAMA Network Open.
- Hypertensive patients accounted for 42.6% and 42.1% pre-COVID and COVID-era in-person visits versus 49.9% of COVID-era telephone visits
- Heart failure patients accounted for 16.4% and 14.1% of those in-person visits but 24.8% and 25.8% of COVID-era video and telephone visits, respectively
“The promise of telemedicine has always been tempered by concerns about disparities in access driven by the digital divide,” the researchers wrote. “Individuals who are older, have lower income, have less education, an underrepresented racial or ethnic group, live in rural areas, and have more chronic conditions are known to have less access to the internet and therefore possibly telemedicine services, especially video visits which require more technology investment and literacy.”
The results were “a little more nuanced than what we might have gone in thinking,” Yuan told MedPage Today.
There are a few potential reasons for the differences in the Los Angeles findings, Yuan suggested.
His group’s study encompassed electronic health records data for all ambulatory cardiology visits across the 31 Cedars-Sinai system clinics from April 1 to December 31 in 2019 and in 2020. That amounted to 87,182 in-person visits pre-pandemic and 74,498 in the COVID-era, along with 4,720 video and 10,381 telephone visits during the pandemic.
While 71.9% of the population was non-Hispanic white, the entire population was “heavily enriched” for private insurance and Medicare — often a signal of higher socioeconomic status, Yuan noted.
“In some ways we are piecing out the race piece from the socioeconomic piece,” he told MedPage Today. “Those things often travel together.”
As expected, privately insured patients accounted for a bigger proportion of COVID-era telehealth visits: 39.1% and 34.2% of in-person visits before and during the pandemic, respectively, versus 54.3% of COVID-era video visits and 41.1% of COVID-era phone visits (both P<0.001).
Another possibility is that virtual visits were disproportionately appealing to minorities due to their outsized role as essential workers unable to take off work hours for medical visits or due to trouble with transportation in a place like Los Angeles with relatively poor public transportation infrastructure, Yuan suggested.
Also, the racial and ethnic minority groups and those with comorbidities might have known they’re at higher COVID-19 risk and therefore been more reluctant to come in for in-person visits, Yuan added. “This reluctance could also be on the clinician side as well.”
“While it remains unclear whether such a COVID-19-related effect will persist,” he said, “I think our data does show that in our studied population of mostly insured individuals, the digital divide along racial lines may not now be as prohibitive as before with regards to using remote visits.”
The visits that did happen were different during the pandemic, though.
Even in-person visits had 38% lower odds of ordering any medication and 40% lower odds of ordering an electrocardiogram, but 21% higher odds of ordering an echocardiogram compared with the same period in…0.001).