Department of Family Medicine, University of Michigan, Ann Arbor, MI, United States.
School of Information, University of Michigan, Ann Arbor, MI, United States.
J Med Internet Res. 2023 Sep 29;25:e49804. doi: 10.2196/49804.
The COVID-19 pandemic resulted in rapid changes in how patient care was provided, particularly through the expansion of telehealth and audio-only phone-based care.
The goal of this study was to evaluate inequities in video and audio-only care during various time points including the initial wave of the COVID-19 pandemic, later stages of the pandemic, and a historical control. We sought to understand the characteristics of care during this time for a variety of different groups of patients that may experience health care inequities.
We conducted a retrospective analysis of electronic health record (EHR) data from encounters from 34 family medicine and internal medicine primary care clinics in a large, Midwestern health system, using a repeated cross-sectional, observational study design. These data included patient demographic data, as well as encounter, diagnosis, and procedure records. Data were obtained for all in-person and telehealth encounters (including audio-only phone-based care) that occurred during 3 separate time periods: an initial COVID-19 period (T2: March 16, 2020, to May 3, 2020), a later COVID-19 period (T3: May 4, 2020, to September 30, 2020), and a historical control period from the previous year (T1: March 16, 2019, to September 30, 2019). Primary analysis focused on the status of each encounter in terms of whether it was completed as scheduled, it was canceled, or the patient missed the appointment. A secondary analysis was performed to evaluate the likelihood of an encounter being completed based on visit modality (phone, video, in-person).
In total, there were 938,040 scheduled encounters during the 3 time periods, with 178,747 unique patients, that were included for analysis. Patients with completed encounters were more likely to be younger than 65 years old (71.8%-74.1%), be female (58.8%-61.8%), be White (75.6%-76.7%), and have no significant comorbidities (63.2%-66.8%) or disabilities (53.2%-61.1%) in all time periods than those who had only canceled or missed encounters. Effects on different subpopulations are discussed herein.
Findings from this study demonstrate that primary care utilization across delivery modalities (in person, video, and phone) was not equivalent across all groups before and during the COVID-19 pandemic and different groups were differentially impacted at different points. Understanding how different groups of patients responded to these rapid changes and how health care inequities may have been affected is an important step in better understanding implementation strategies for digital solutions in the future.
COVID-19 大流行导致患者护理方式发生了快速变化，特别是通过扩大远程医疗和仅音频电话护理。
本研究的目的是评估在 COVID-19 大流行的不同阶段（包括最初阶段、后期阶段和历史对照）中视频和仅音频护理的不平等现象。我们试图了解在此期间不同患者群体的护理特点，这些患者群体可能存在医疗保健不平等现象。
我们对来自一家大型中西部医疗系统 34 家家庭医学和内科初级保健诊所的电子健康记录 (EHR) 数据进行了回顾性分析，使用重复横断面、观察性研究设计。这些数据包括患者人口统计学数据以及就诊、诊断和程序记录。我们获得了在三个不同时间段内发生的所有面对面和远程医疗（包括仅音频电话护理）就诊的数据：初始 COVID-19 期间（T2：2020 年 3 月 16 日至 2020 年 5 月 3 日）、后期 COVID-19 期间（T3：2020 年 5 月 4 日至 2020 年 9 月 30 日）和前一年的历史对照期（T1：2019 年 3 月 16 日至 2019 年 9 月 30 日）。主要分析侧重于每个就诊的状态，即是否按计划完成、取消或患者错过预约。进行了二次分析以评估基于就诊方式（电话、视频、面对面）完成就诊的可能性。
在三个时间段内，共有 938,040 次预约，涉及 178,747 名独特患者，进行了分析。完成就诊的患者比仅取消或错过就诊的患者更年轻（71.8%-74.1%），更可能是女性（58.8%-61.8%），是白人（75.6%-76.7%），且无重大合并症（63.2%-66.8%）或残疾（53.2%-61.1%）。本文讨论了对不同亚群的影响。
本研究结果表明，在 COVID-19 大流行之前和期间，不同人群通过各种提供方式（面对面、视频和电话）进行的初级保健利用并不均等，不同人群在不同时间点受到的影响也不同。了解不同患者群体对这些快速变化的反应以及医疗保健不平等现象可能受到的影响，是更好地理解未来数字解决方案实施策略的重要一步。
