Demographic Disparities in Telemedicine Use During the COVID-19 Pandemic

When the COVID-19 pandemic made in-person health checkups difficult or impossible, telemedicine proved a viable alternative. However, patients with limited digital literacy or technology access experience reduced telemedicine benefits.

Over 21 million people in the US lack access to broadband internet, and ownership of internet-capable devices is disproportionately low among older and low-income Americans. One study, published in the Journal of the American College of Surgeons, researched the demographic disparities of in-person versus virtual health consultations.

Investigators from the Center for Surgery and Public Health at Brigham and Women’s Hospital conducted a retrospective analysis within the division of general and gastrointestinal surgery from March 24-June 23, 2020 (phase 1) and June 24-December 31, 2020.

The investigators analyzed 4908 patients across both phases. During phase 1, there were 347 in-person and 638 virtual visits. There were initially no significant differences in type of visit across demographic or insurance groups. Among the virtual visits, Latinx and Hispanic patients were less likely to have video capability during their visits than white patients.

During phase 2, there were 2922 in-person and 1001 virtual visits. Once again, there was no significant difference in visit preference by insurance type, but Black patients were more likely to opt for virtual visits than white patients.

The key findings were that Black patients relied on virtual visits as an essential healthcare resource during the pandemic. As anticipated, there were disparities in the use of video streaming during the virtual visits among vulnerable populations. Additionally, older age, lower level of education, and non-English as a primary language were correlated with decreased video use.

Notably, the study did not include qualitative research of the fundamental drivers of differences in audio-only versus video usage during the virtual visits. The investigators recommended further study to qualitatively analyze patient, provider, and system-level drivers of visit type.

Study coauthor Ali Tavakkoli, MD, chief of the division of general and gastrointestinal surgery at Brigham and Women’s Hospital, said, “It’s really interesting to sit here in January 2022 and analyze data on virtual care where about two years ago, we hardly ever used virtual care. The first wave of COVID pushed us to implement this path and format of care where we thought it would not be possible. Now the data, including this study, show that it can be done, and it can be done safely. During the current wave of COVID where we’ve become heavily dependent on virtual visits again, it’s great to have this data to show how we’re doing with this format.”