Grady Connor B, Claus Elizabeth B, Bunn David A, Pagliaro Jaclyn A, Lichtman Judith H, Bhatt Ami B
Department of Chronic Disease Epidemiology, Yale School of Public Health, 60 College Street, New Haven, CT 06519, USA.
Department of Biostatistics, Yale School of Public Health, 60 College Street, New Haven, CT 06510.
Eur Heart J Digit Health. 2021 Jul 27;2(4):691-694. doi: 10.1093/ehjdh/ztab067. eCollection 2021 Dec.
Known racial, ethnic, age, and socioeconomic disparities in video telemedicine engagement may widen existing health inequities. We assessed if telemedicine disparities were alleviated among patients of high-video-use providers at a large cardiovascular practice.
All telemedicine visits from 16 March to 31 October 2020 and patient demographics were collected from an administrative database. Providers in the upper quintile of video use were classified as high-video-use providers. Descriptive statistics and a multivariable logistic model were calculated to determine the distribution and predictors of a patient ever having a video visit vs. only phone visits. A total of 24 470 telemedicine visits were conducted among 18 950 patients by 169 providers. Video visits accounted for 48% of visits (52% phone). Among telemedicine visits conducted by high-video-use providers ( = 33), ever video patients were younger ( < 0.001) and included 78% of Black patients vs. 86% of White patients ( < 0.001), 74% of Hispanic patients vs. 86% of non-Hispanic patients ( < 0.001), and 79% of public insurance patients vs. 91% of private insurance patients ( < 0.001). High-video-use provider patients had 9.4 (95% confidence interval 8.4-10.4) times the odds of having video visit compared to low-video-use provider patients.
These results suggest that provider-focused solutions alone, including promoting provider adoption of video visits, may not adequately reduce disparities in telemedicine engagement. Even in the presence of successful clinical infrastructure for telemedicine, individuals of Black race, Hispanic ethnicity, older age, and with public insurance continue to have decreased engagement. To achieve equity in telemedicine, patient-focused design is needed.
视频远程医疗参与度方面已知的种族、民族、年龄和社会经济差异可能会扩大现有的健康不平等。我们评估了在一家大型心血管诊所中，高视频使用量提供者的患者之间远程医疗差异是否得到缓解。
收集了2020年3月16日至10月31日期间所有远程医疗就诊信息以及患者人口统计学数据，数据来自行政数据库。视频使用量处于上五分位数的提供者被归类为高视频使用量提供者。计算描述性统计数据和多变量逻辑模型，以确定患者进行视频就诊与仅进行电话就诊的分布情况及预测因素。169名提供者为18950名患者进行了总共24470次远程医疗就诊。视频就诊占就诊总数的48%（电话就诊占52%）。在高视频使用量提供者（n = 33）进行的远程医疗就诊中，进行过视频就诊的患者更年轻（P < 0.001），其中黑人患者占78%，而白人患者占86%（P < 0.001）；西班牙裔患者占74%，而非西班牙裔患者占86%（P < 0.001）；公共保险患者占79%，而私人保险患者占91%（P < 0.001）。与低视频使用量提供者的患者相比，高视频使用量提供者的患者进行视频就诊的几率高出9.4倍（95%置信区间8.4 - 10.4）。
这些结果表明，仅关注提供者的解决方案，包括促进提供者采用视频就诊，可能无法充分减少远程医疗参与度方面的差异。即使存在成功的远程医疗临床基础设施，黑人种族、西班牙裔民族、年龄较大以及拥有公共保险的个体的参与度仍然较低。为了实现远程医疗的公平性，需要以患者为中心的设计。
