From the Harvard Medical School, Boston, MA (Eruchalu).
Center for Surgery and Public Health, Department of Surgery (Eruchalu, Bergmark, Smink, Nguyen, Cooper, Ortega), Brigham and Women's Hospital, Harvard Medical School, Boston, MA.
J Am Coll Surg. 2022 Feb 1;234(2):191-202. doi: 10.1097/XCS.0000000000000030.
Surgical patients with limited digital literacy may experience reduced telemedicine access. We investigated racial/ethnic and socioeconomic disparities in telemedicine compared with in-person surgical consultation during the coronavirus disease 2019 (COVID-19) pandemic.
Retrospective analysis of new visits within the Division of General & Gastrointestinal Surgery at an academic medical center occurring between March 24 through June 23, 2020 (Phase I, Massachusetts Public Health Emergency) and June 24 through December 31, 2020 (Phase II, relaxation of restrictions on healthcare operations) was performed. Visit modality (telemedicine/phone vs in-person) and demographic data were extracted. Bivariate analysis and multivariable logistic regression were performed to evaluate associations between patient characteristics and visit modality.
During Phase I, 347 in-person and 638 virtual visits were completed. Multivariable modeling demonstrated no significant differences in virtual compared with in-person visit use across racial/ethnic or insurance groups. Among patients using virtual visits, Latinx patients were less likely to have video compared with audio-only visits than White patients (OR, 0.46; 95% CI 0.22-0.96). Black race and insurance type were not significant predictors of video use. During Phase II, 2,922 in-person and 1,001 virtual visits were completed. Multivariable modeling demonstrated that Black patients (OR, 1.52; 95% CI 1.12-2.06) were more likely to have virtual visits than White patients. No significant differences were observed across insurance types. Among patients using virtual visits, race/ethnicity and insurance type were not significant predictors of video use.
Black patients used telemedicine platforms more often than White patients during the second phase of the COVID-19 pandemic. Virtual consultation may help increase access to surgical care among traditionally under-resourced populations.
数字素养有限的外科患者可能会减少远程医疗的机会。我们研究了在 2019 冠状病毒病（COVID-19）大流行期间，与面对面手术咨询相比，远程医疗在种族/民族和社会经济方面的差异。
对 2020 年 3 月 24 日至 6 月 23 日（第一阶段，马萨诸塞州公共卫生紧急状态）和 2020 年 6 月 24 日至 12 月 31 日（第二阶段，放宽医疗运营限制）期间在普通和胃肠外科科内进行的新就诊进行回顾性分析。提取就诊方式（远程医疗/电话与面对面）和人口统计学数据。进行了单变量分析和多变量逻辑回归，以评估患者特征与就诊方式之间的关联。
在第一阶段，完成了 347 次面对面和 638 次虚拟就诊。多变量建模显示，在各种种族/民族和保险群体中，虚拟就诊与面对面就诊的使用没有显著差异。在使用虚拟就诊的患者中，拉丁裔患者与白人患者相比，进行视频就诊的可能性较小，而进行音频就诊的可能性较大（比值比，0.46；95%置信区间，0.22-0.96）。黑人种族和保险类型不是视频使用的显著预测因素。在第二阶段，完成了 2922 次面对面和 1001 次虚拟就诊。多变量建模显示，黑人患者（比值比，1.52；95%置信区间，1.12-2.06）比白人患者更有可能进行虚拟就诊。在各种保险类型之间未观察到显著差异。在使用虚拟就诊的患者中，种族/民族和保险类型不是视频使用的显著预测因素。
在 COVID-19 大流行的第二阶段，黑人患者比白人患者更频繁地使用远程医疗平台。虚拟咨询可能有助于增加传统资源不足人群获得外科护理的机会。
