Department of Otolaryngology-Head & Neck Surgery, Henry Ford Hospital, Detroit, Michigan.
JAMA Otolaryngol Head Neck Surg. 2021 Mar 1;147(3):287-295. doi: 10.1001/jamaoto.2020.5161.
The coronavirus disease 2019 (COVID-19) pandemic required the rapid transition to telehealth with the aim of providing patients with medical access and supporting clinicians while abiding by the stay-at-home orders.
To assess demographic and socioeconomic factors associated with patient participation in telehealth during the COVID-19 pandemic.
DESIGN, SETTING, AND PARTICIPANTS: This cohort study included all pediatric and adult patient encounters at the Department of Otolaryngology-Head & Neck Surgery in a tertiary care, academic, multisubspecialty, multisite practice located in an early hot spot for the COVID-19 pandemic from March 17 to May 1, 2020. Encounters included completed synchronous virtual, telephone, and in-person visits as well as visit no-shows.
Patient demographic characteristics, insurance status, and 2010 Census block level data as a proxy for socioeconomic status were extracted. Univariate and multivariate logistic regression models were created for patient-level comparisons.
Of the 1162 patients (604 females [52.0%]; median age, 55 [range, 0-97] years) included, 990 completed visits; of these, 437 (44.1%) completed a virtual visit. After multivariate adjustment, females (odds ratio [OR], 1.71; 95% CI, 1.11-2.63) and patients with preferred provider organization insurance (OR, 2.70; 95% CI, 1.40-5.20) were more likely to complete a virtual visit compared with a telephone visit. Increasing age (OR per year, 0.98; 95% CI, 0.98-0.99) and being in the lowest median household income quartile (OR, 0.60; 95% CI, 0.42-0.86) were associated with lower odds of completing a virtual visit overall. Those patients within the second (OR, 0.53; 95% CI, 0.28-0.99) and lowest (OR, 0.33; 95% CI, 0.17-0.62) quartiles of median household income by census block and those with Medicaid, no insurance, or other public insurance (OR, 0.47; 95% CI, 0.23-0.94) were more likely to complete a telephone visit. Finally, being within the lower 2 quartiles of proportion being married (OR for third quartile, 0.49 [95% CI, 0.29-0.86]; OR for lowest quartile, 0.39 [95% CI, 0.23-0.67]) was associated with higher likelihood of a no-show visit.
These findings suggest that age, sex, median household income, insurance status, and marital status are associated with patient participation in telehealth. These findings identify vulnerable patient populations who may not engage with telehealth, yet still require medical care in a changing health care delivery landscape.
2019 年冠状病毒病（COVID-19）大流行要求快速过渡到远程医疗，目的是为患者提供医疗服务，并在遵守居家令的同时支持临床医生。
评估与 COVID-19 大流行期间患者参与远程医疗相关的人口统计学和社会经济因素。
设计、地点和参与者：这项队列研究包括 2020 年 3 月 17 日至 5 月 1 日期间，在一个三级保健、学术、多专科、多地点的耳鼻喉科-头颈外科部门的所有儿科和成人患者就诊，该部门位于 COVID-19 大流行的早期热点地区。就诊包括已完成的同步虚拟、电话和面对面就诊以及就诊未到。
提取了患者人口统计学特征、保险状况和 2010 年人口普查街区级数据作为社会经济地位的代表。为患者层面的比较创建了单变量和多变量逻辑回归模型。
在 1162 名患者（604 名女性[52.0%]；中位年龄，55[范围，0-97]岁）中，有 990 名完成了就诊；其中 437 名（44.1%）完成了虚拟就诊。经过多变量调整后，女性（比值比[OR]，1.71；95%CI，1.11-2.63）和有首选提供者组织保险的患者（OR，2.70；95%CI，1.40-5.20）与电话就诊相比，更有可能完成虚拟就诊。年龄每增加 1 岁（OR 每年，0.98；95%CI，0.98-0.99）和处于最低中位数家庭收入四分位数的患者（OR，0.60；95%CI，0.42-0.86）总体上完成虚拟就诊的可能性较低。那些在第二（OR，0.53；95%CI，0.28-0.99）和最低（OR，0.33；95%CI，0.17-0.62）中位数家庭收入四分位数的患者和那些有医疗补助、没有保险或其他公共保险的患者（OR，0.47；95%CI，0.23-0.94）更有可能完成电话就诊。最后，在婚姻状况处于较低的前 2 个四分位数的患者（第三四分位数的 OR，0.49[95%CI，0.29-0.86]；最低四分位数的 OR，0.39[95%CI，0.23-0.67]）与未就诊的可能性更高相关。
这些发现表明，年龄、性别、中位数家庭收入、保险状况和婚姻状况与患者参与远程医疗有关。这些发现确定了可能无法参与远程医疗但仍在不断变化的医疗服务提供环境中需要医疗服务的弱势患者群体。
