Division of Gastroenterology and Liver Diseases, Department of Medicine, The George Washington University, Washington, D.C, USA.
Division of Gastroenterology and Liver Diseases, Department of Medicine, The George Washington University, Washington, D.C, USA.
J Natl Med Assoc. 2021 Aug;113(4):474-477. doi: 10.1016/j.jnma.2021.03.005. Epub 2021 Apr 30.
Electronic messaging and telemedicine visits increased during the COVID pandemic. African-Americans and older patients have less frequently used electronic messaging with their physicians. This study compares the utilization of virtual health care before and during the COVID pandemic for inflammatory bowel disease (IBD) patients.
A chart review of all IBD patients seen at an academic medical center from 2014-2020 was conducted to evaluate the use of telehealth options (e-messaging, e-visits) during a pre-COVID and COVID timeframe. Analysis of telehealth use from March - August 2018 and March - August 2020 was performed. Patient age, gender, race, IBD type, electronic messaging and telehealth visits were obtained. A confidential database was created. Statistical analysis was performed using Fisher Exact test with significance set at p < 0.05. The study was IRB approved.
392 patients were in the pre-COVID cohort. There were 204 White, 99 African-American, 11 Asian, and 78 racially un-identified patients. 160 (40.8%) initiated E-communication with their physicians. There was a significant difference in the use of e-messaging based upon age (51.1% < 50 vs 39.7% ≥ 50; p = 0.0396) and race (62.3% White vs 28.2% African-American; p < 0.00001).There were no significant differences in the use of e-messaging based upon patient gender (p = 0.6840) or IBD type (p = 0.6374). There were 295 patients in the COVID cohort. There were 155 White, 83 African American patients, 24 Hispanic patients, 10 Asian patients, and 22 racially un-identified patients. 109 (36.9%) utilized a telehealth option (53 via e-messaging; 56 via telemedicine visit). There was no significant difference in the use of a telehealth option based upon age (36.8% < 50 vs 37.25% ≥ 50 years; p = 1.00), race (42.6% White vs 35.9% African-American; p = 0.2693) or IBD type (p = 0.331). Males used telehealth more than females (46.1% vs 29.7%, respectively; p = 0.0051).
The COVID pandemic emergency increased e-visits and e-messaging for care delivery. Expanded telemedicine options for IBD patients eliminated previously identified racial and age disparities in virtual medical care. African Americans utilized electronic communication as frequently as Whites during the pandemic. Post-pandemic policy consideration for continued telemedicine options may expand patient-physician engagement and eliminate disparities in health care.
在 COVID 大流行期间，电子消息传递和远程医疗访问量增加。非裔美国人和老年患者较少使用与医生的电子消息传递。本研究比较了 COVID 大流行前后炎症性肠病 (IBD) 患者使用虚拟医疗保健的情况。
对在学术医疗中心就诊的所有 IBD 患者进行了图表回顾，以评估在 COVID 前和 COVID 期间使用远程医疗选项（电子消息传递、电子就诊）的情况。对 2018 年 3 月至 8 月和 2020 年 3 月至 8 月的远程医疗使用情况进行了分析。获取了患者年龄、性别、种族、IBD 类型、电子消息传递和远程医疗就诊的信息。创建了一个机密数据库。使用 Fisher 精确检验进行统计分析，显著性水平设为 p < 0.05。该研究得到了机构审查委员会的批准。
392 名患者在 COVID 前队列中。其中有 204 名白人、99 名非裔美国人、11 名亚洲人和 78 名种族未识别患者。160 名（40.8%）与他们的医生发起了电子通讯。根据年龄（51.1%<50 岁与 39.7%≥50 岁；p=0.0396）和种族（62.3%白人与 28.2%非裔美国人；p<0.00001），电子消息传递的使用存在显著差异。根据患者性别（p=0.6840）或 IBD 类型（p=0.6374），电子消息传递的使用没有显著差异。在 COVID 队列中有 295 名患者。其中有 155 名白人、83 名非裔美国人、24 名西班牙裔、10 名亚洲人和 22 名种族未识别患者。109 名（36.9%）使用了远程医疗选项（53 名通过电子消息传递；56 名通过远程医疗就诊）。根据年龄（36.8%<50 岁与 37.25%≥50 岁；p=1.00）、种族（42.6%白人与 35.9%非裔美国人；p=0.2693）或 IBD 类型（p=0.331），使用远程医疗选项没有显著差异。男性比女性更常使用远程医疗（分别为 46.1%和 29.7%；p=0.0051）。
COVID 大流行紧急情况增加了电子就诊和电子医疗保健的提供。为 IBD 患者提供扩展的远程医疗选择消除了以前在虚拟医疗保健方面存在的种族和年龄差异。非裔美国人在大流行期间与白人一样频繁使用电子通讯。大流行后远程医疗选择的政策考虑可能会扩大医患参与度，并消除医疗保健方面的差距。
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