University of Houston, College of Medicine, 4849 Calhoun Road, Bldg 2, Houston, TX, 77204, USA.
Humana Integrated Health Systems Sciences Institute, Houston, TX, USA.
J Gen Intern Med. 2022 Apr;37(5):1191-1197. doi: 10.1007/s11606-021-07304-4. Epub 2022 Feb 2.
The Coronavirus Aid, Relief, and Economic Security (CARES) Act led to the rapid implementation of telemedicine across healthcare office settings. This innovation has the potential to improve healthcare use and ensure continuity of care. However, this delivery model could have an unintended consequence of worsening racial/ethnic disparities in healthcare utilization if adoption varies across sub-populations.
To examine associations between telemedicine use and race/ethnicity between 3/1/2020 and 11/30/2020, and the influence of other individual- and geographical-level factors on this relationship.
Cohort study PARTICIPANTS: EMR data from 55 clinics in a FQHC network MAIN MEASURES: The dependent variable was visit type (in-person vs. telemedicine). Predictors of interest were patient race and ethnicity. To account for repeated visits within each patient nested within clinic, a three-level, mixed-effects, multivariable, logistic regression model was used. Subgroup analyses examined correlates of telemedicine use in African American and Hispanic cohorts, separately.
The analytic sample included 233,302 visits for 67,733 unique patients. African Americans (OR = 0.65, 95% CI: 0.61, 0.69), Asians (OR = 0.58, 95% CI: 0.52, 0.65), and American Indians / Alaska Natives and other Pacific Islanders (OR = 0.82, 95% CI: 0.70, 0.98) were significantly less likely to use telemedicine compared to Whites. Hispanics were also less likely to have a telemedicine visit (OR = 0.49, 95% CI: 0.47, 0.51) compared to non-Hispanics. Nonacute visits were more likely to be conducted via telemedicine. Distance to clinic exhibited a dose-response relationship such that patients who lived farthest from the clinics were most likely to have telemedicine visits. In the subgroup analyses to examine predictors of telemedicine use, the dose-response relationship between distance from clinic and telemedicine use persisted, with increasing distance associated with increasing likelihood of telemedicine use, in both African American and Hispanic cohorts. Nonacute visits were associated with telemedicine use in the Hispanic cohort, but not in the Black / African American cohort.
Racial/ethnic disparities in telemedicine use persisted among this cohort. However, telemedicine improved utilization for African Americans and Hispanics living farther away from the clinic.
《冠状病毒援助、救济和经济安全法案》（CARES 法案）导致远程医疗在医疗办公室环境中迅速普及。这种创新有可能改善医疗保健的使用并确保医疗保健的连续性。然而，如果不同人群的采用情况存在差异，这种交付模式可能会对医疗保健利用方面的种族/民族差异产生意想不到的影响。
检查 2020 年 3 月 1 日至 11 月 30 日期间，远程医疗使用与种族/民族之间的关联，以及个体和地理水平的其他因素对这种关系的影响。
队列研究
来自 FQHC 网络中 55 个诊所的 EMR 数据
因变量是就诊类型（门诊就诊与远程医疗就诊）。感兴趣的预测因素是患者的种族和民族。为了在嵌套在诊所内的每个患者的重复就诊中进行说明，使用了三级、混合效应、多变量、逻辑回归模型。亚组分析分别检查了非裔美国人和西班牙裔人群中远程医疗使用的相关因素。
分析样本包括 233302 次就诊和 67733 位患者。非裔美国人（OR=0.65，95%CI：0.61，0.69）、亚洲人（OR=0.58，95%CI：0.52，0.65）和美洲印第安人/阿拉斯加原住民和其他太平洋岛民（OR=0.82，95%CI：0.70，0.98）使用远程医疗的可能性明显低于白人。与非西班牙裔相比，西班牙裔使用远程医疗就诊的可能性也较低（OR=0.49，95%CI：0.47，0.51）。非急性就诊更有可能通过远程医疗进行。到诊所的距离呈剂量反应关系，即距离诊所最远的患者最有可能进行远程医疗就诊。在亚组分析中，检查远程医疗使用的预测因素时，距离诊所和远程医疗使用之间的剂量反应关系仍然存在，距离诊所越远，进行远程医疗的可能性就越大，在非裔美国人和西班牙裔队列中都是如此。非急性就诊与西班牙裔人群的远程医疗使用相关，但与非裔美国人群无关。
在该队列中，远程医疗使用方面仍然存在种族/民族差异。然而，远程医疗改善了居住在离诊所较远的非裔美国人和西班牙裔人群的利用率。
