Katzow Michelle W, Steinway Caren, Zuzarte Andrea, Chen Jack, Fishbein Joanna, Jan Sophia
Department of Pediatrics, Cohen Children's Medical Center of Northwell Health, New Hyde Park, New York, USA.
Center for Health Innovations and Outcomes Research, Institute for Health Systems Science, Feinstein Institutes for Medical Research, Manhasset, New York, USA.
Telemed J E Health. 2024 Jan;30(1):57-66. doi: 10.1089/tmj.2023.0005. Epub 2023 Aug 9.
Objective:Few studies have examined sociodemographic disparities in ambulatory pediatric telemedicine utilization during the coronavirus disease 2019 pandemic. We aimed to (1) assess disparities in telemedicine visit completion during the first 6 weeks of the pandemic in 2020 and (2) determine if these disparities were significantly different from those present in 2019, when all visits occurred in person.
Methods:We compared sociodemographic characteristics of patients with successful versus unsuccessful telemedicine visits from March 10, 2020 to April 18, 2020, using generalized linear mixed models. We performed the same analysis for in-person visits from the same period in 2019. We tested for differences across years using interaction terms in a combined 2019-2020 model.
Results: Of 3,639 telemedicine visits scheduled, 3,033 (83.3%) were successful. In 2020, Black/African American race was significantly associated with lower odds of telemedicine visit success (odds ratio 0.65 [95% confidence interval 0.49-0.87]) compared with White race, after adjusting for age, gender, ethnicity, insurance type, visit timing, visit specialty, social vulnerability index, and internet access. In 2019, racial identity other than White was significantly associated with lower odds of in-person visit success than White, as was public insurance compared with private. In the full 2019-2020 model, in-person visits (2019) had lower odds of success than telemedicine visits (2020), and neither race, insurance type, nor any other sociodemographic characteristic had significant interactions with year.
Conclusions: Racial disparities were evident in telemedicine utilization early in the pandemic; however, these disparities were not significantly different from those seen in 2019, when all visits were in person. Furthermore, telemedicine may improve access to care overall, despite having no significant impact on inequity. Efforts to eliminate racial disparities in ambulatory pediatric health care utilization are necessary across visit modalities.
很少有研究调查2019年冠状病毒病大流行期间儿科门诊远程医疗使用中的社会人口统计学差异。我们旨在：（1）评估2020年大流行前6周内远程医疗就诊完成情况的差异；（2）确定这些差异是否与2019年所有就诊均为面对面就诊时存在的差异有显著不同。
我们使用广义线性混合模型，比较了2020年3月10日至2020年4月18日成功和未成功进行远程医疗就诊的患者的社会人口统计学特征。我们对2019年同期的面对面就诊进行了相同的分析。我们在2019 - 2020年综合模型中使用交互项检验各年份之间的差异。
在安排的3639次远程医疗就诊中，3033次（83.3%）成功。在2020年，在调整了年龄、性别、种族、保险类型、就诊时间、就诊专科、社会脆弱性指数和互联网接入情况后，与白人相比，黑人/非裔美国人种族的远程医疗就诊成功率显著较低（优势比0.65[95%置信区间0.49 - 0.87]）。在2019年，非白人种族身份与面对面就诊成功率低于白人显著相关，公共保险与私人保险相比也是如此。在完整的2019 - 2020年模型中，2019年的面对面就诊成功率低于2020年的远程医疗就诊成功率，并且种族、保险类型或任何其他社会人口统计学特征与年份均无显著交互作用。
在大流行早期，远程医疗使用中的种族差异明显；然而，这些差异与2019年所有就诊均为面对面就诊时所见的差异并无显著不同。此外，尽管对不平等没有显著影响，但远程医疗可能总体上改善了医疗服务的可及性。在所有就诊方式中，都需要努力消除儿科门诊医疗使用中的种族差异。
