Department of Surgery, University of Virginia Health System, Charlottesville, Virginia, United States of America.
Department of Surgical Oncology, The University of Texas MD Anderson Cancer Center, Houston, Texas, United States of America.
PLoS One. 2021 Oct 8;16(10):e0258452. doi: 10.1371/journal.pone.0258452. eCollection 2021.
Telemedicine has been rapidly adopted in the wake of the COVID-19 pandemic. There is limited work surrounding demographic and socioeconomic disparities that may exist in telemedicine utilization. This study aimed to examine demographic and socioeconomic differences in surgical patient telemedicine usage during the COVID-19 pandemic.
Department of Surgery outpatients seen from July 1, 2019 to May 31, 2020 were stratified into three visit groups: pre-COVID-19 in-person, COVID-19 in-person, or COVID-19 telemedicine. Generalized linear models were used to examine associations of sex, race/ethnicity, Distressed Communities Index (DCI) scores, MyChart activation, and insurance status with telemedicine usage during the COVID-19 pandemic.
14,792 patients (median age 60, female [57.0%], non-Hispanic White [76.4%]) contributed to 21,980 visits. Compared to visits before the pandemic, telemedicine visits during COVID-19 were more likely to be with patients from the least socioeconomically distressed communities (OR, 1.31; 95% CI, 1.08,1.58; P = 0.005), with an activated MyChart (OR, 1.38; 95% CI, 1.17-1.64; P < .001), and with non-government or commercial insurance (OR, 2.33; 95% CI, 1.84-2.94; P < .001). Adjusted comparison of telemedicine visits to in person visits during COVID-19 revealed telemedicine users were more likely to be female (OR, 1.38, 95% CI, 1.10-1.73; P = 0.005) and pay with non-government or commercial insurance (OR, 2.77; 95% CI, 1.85-4.16; P < .001).
During the first three months of the COVID-19 pandemic, telemedicine was more likely utilized by female patients and those without government or commercial insurance compared to patients who used in-person visits. Interventions using telemedicine to improve health care access might consider such differences in utilization.
在 COVID-19 大流行之后，远程医疗迅速得到采用。在远程医疗利用方面，存在着人口统计学和社会经济差异方面的工作有限。本研究旨在检查 COVID-19 大流行期间外科患者远程医疗使用的人口统计学和社会经济差异。
将 2019 年 7 月 1 日至 2020 年 5 月 31 日期间的外科门诊患者分为三组：COVID-19 大流行前的门诊、COVID-19 大流行期间的门诊和 COVID-19 大流行期间的远程医疗。使用广义线性模型来检查性别、种族/族裔、困境社区指数（DCI）评分、MyChart 激活和保险状况与 COVID-19 大流行期间远程医疗使用的关联。
14792 名患者（中位数年龄为 60 岁，女性[57.0%]，非西班牙裔白人[76.4%]）贡献了 21980 次就诊。与大流行前的就诊相比，COVID-19 期间的远程医疗就诊更有可能来自社会经济最不困难的社区（OR，1.31；95%CI，1.08，1.58；P = 0.005），患者已激活 MyChart（OR，1.38；95%CI，1.17-1.64；P <.001），且拥有非政府或商业保险（OR，2.33；95%CI，1.84-2.94；P <.001）。对 COVID-19 期间远程医疗就诊与门诊就诊的调整后比较显示，远程医疗就诊者更可能为女性（OR，1.38，95%CI，1.10-1.73；P = 0.005），且更有可能使用非政府或商业保险（OR，2.77；95%CI，1.85-4.16；P <.001）。
在 COVID-19 大流行的头三个月中，与使用门诊就诊的患者相比，远程医疗更可能被女性患者和没有政府或商业保险的患者使用。利用远程医疗改善医疗保健获取的干预措施可能需要考虑到这种利用上的差异。
