Yale University School of Medicine, New Haven, CT.
Boston Children's Hospital, Boston, MA.
J Pediatr Gastroenterol Nutr. 2021 Aug 1;73(2):217-222. doi: 10.1097/MPG.0000000000003167.
While the use of telemedicine has accelerated significantly with the recent pandemic, it has also magnified disparities in access to telemedicine. This study aims to look at telemedicine utilization patterns within a large pediatric gastroenterology practice.
A retrospective study of ambulatory care visits within Yale-New Haven Hospital's pediatric gastroenterology practice during the peak expansion of the telemedicine program was conducted. Zip code-level socioeconomic data were obtained using the Distressed Communities Index. A multivariate logistic regression to evaluate disparities between the use of video versus telephone visits was computed, and unadjusted and adjusted odds ratios with 95% confidence intervals (CIs) were obtained.
A total of 1273 clinic visits were included in analysis. The majority of the patients listed English as their preferred language, had private insurance, and identified as non-Hispanic White. When adjusting for co-variates, having public insurance/Medicaid was associated with decreased odds of having video over telephone visits (adjusted odds ratio [aOR] 0.60; 95% CI 0.44-0.80). Those whose primary language was not English continued to have a statistically significant decreased odds of using video visits (Spanish aOR 0.24; 95% CI 0.13-0.44; other aOR 0.29; 95% CI 0.12-0.72). Within the adjusted multivariate logistic regression, race/ethnicity and SES were, however, no longer found to have a statistically significant decreased odds of video visits.
The accelerated implementation of telemedicine within pediatric gastroenterology has given rise to disparities in its use. Further studies are needed to understand these disparities and develop interventions to lessen this gap in usage.
随着最近大流行期间远程医疗的使用显著加速，它也放大了远程医疗获取方面的差距。本研究旨在观察一家大型儿科胃肠病学实践中远程医疗的使用模式。
对耶鲁-纽黑文医院儿科胃肠病学实践中远程医疗计划高峰期内的门诊就诊进行回顾性研究。使用困境社区指数获取邮政编码级别的社会经济数据。计算了评估视频与电话就诊使用差异的多变量逻辑回归，并获得了未调整和调整后的比值比及其 95%置信区间（CI）。
共纳入 1273 例门诊就诊。大多数患者首选英语，拥有私人保险，且为非西班牙裔白人。在调整协变量后，拥有公共保险/医疗补助与视频就诊的可能性降低相关（调整后的比值比[aOR]0.60；95%CI0.44-0.80）。主要语言不是英语的患者继续使用视频就诊的可能性显著降低（西班牙语 aOR0.24；95%CI0.13-0.44；其他 aOR0.29；95%CI0.12-0.72）。然而，在调整后的多元逻辑回归中，种族/族裔和社会经济地位不再与视频就诊的可能性降低具有统计学意义。
儿科胃肠病学中远程医疗的加速实施导致了其使用的差异。需要进一步研究以了解这些差异，并制定干预措施来缩小使用差距。
