Department of Public Health Sciences, University of Rochester Medical Center, Rochester, New York, USA.
J Am Geriatr Soc. 2024 Sep;72(9):2667-2678. doi: 10.1111/jgs.19039. Epub 2024 Jun 5.
Routine ambulatory care is essential for older adults with Alzheimer's disease and related dementias (ADRD) to manage their health conditions. The federal government expanded telemedicine coverage to mitigate the impact of the COVID-19 pandemic on ambulatory services, which may provide an opportunity to improve access to care. This study aims to examine differences in telemedicine use for ambulatory services by race, ethnicity, and community-level socioeconomic status among community-dwelling older adults with ADRD.
This retrospective cohort study used Medicare claims data between April 01, 2020 and December 31, 2021. We included community-dwelling Medicare fee-for-service beneficiaries aged 65 years and older with ADRD. The outcome variable is individual's use (yes/no) of telemedicine evaluation and management (tele-EM) visits in each quarter. The key independent variables are race, ethnicity, and community-level socioeconomic status.
The analytical sample size of the study was 2,068,937, including 9.9% Black, 82.7% White, and 7.4% Hispanic individuals. In general, we observed a decreasing trend of tele-EM use, and the average rate of quarterly tele-EM use was 23.0%. Tele-EM utilization varied by individual race, ethnicity, and community-level socioeconomic status. On average, White and Black individuals in deprived communities were 3.5 and 2.4 percentage-points less likely to use tele-EM compared with their counterparts in less-deprived communities (p < 0.001). However, Hispanic individuals in deprived communities were 2.4 percentage-points more likely to utilize tele-EM compared with those in less-deprived communities (p < 0.001). Additionally, we observed various racial and ethnic differences in telemedicine use in deprived communities versus less-deprived communities.
We observed various racial and ethnic differences in telemedicine use, both within and between communities by socioeconomic status. Telemedicine is a viable healthcare delivery option that may influence healthcare access for racial and ethnic minorities and for individuals in socioeconomically deprived communities. Further policies or interventions may be needed to ensure all individuals have equal access to newly available care delivery models.
对于患有阿尔茨海默病和相关痴呆症（ADRD）的老年人来说，常规的门诊护理对于控制他们的健康状况至关重要。联邦政府扩大了远程医疗的覆盖范围，以减轻 COVID-19 大流行对门诊服务的影响，这可能为改善护理服务的可及性提供了机会。本研究旨在研究在患有 ADRD 的社区居住的老年人中，种族、民族和社区级社会经济地位对远程医疗用于门诊服务的差异。
本回顾性队列研究使用了 2020 年 4 月 1 日至 2021 年 12 月 31 日期间的 Medicare 索赔数据。我们纳入了年龄在 65 岁及以上、患有 ADRD 的社区居住的 Medicare 按服务收费受益人群。因变量是个体在每个季度是否使用远程医疗评估和管理（远程 EM）就诊（是/否）。关键的独立变量是种族、民族和社区级社会经济地位。
研究的分析样本量为 2068937 人，包括 9.9%的黑人、82.7%的白人、7.4%的西班牙裔个体。总体而言，我们观察到远程 EM 使用呈下降趋势，季度远程 EM 使用的平均比率为 23.0%。远程 EM 的利用情况因个体的种族、民族和社区级社会经济地位而异。平均而言，贫困社区的白人和黑人个体使用远程 EM 的可能性分别比非贫困社区的对应个体低 3.5 和 2.4 个百分点（p<0.001）。然而，贫困社区的西班牙裔个体使用远程 EM 的可能性比非贫困社区的对应个体高 2.4 个百分点（p<0.001）。此外，我们还观察到在贫困社区与非贫困社区之间，远程医疗的使用存在各种种族和民族差异。
我们观察到在远程医疗的使用方面存在各种种族和民族差异，这些差异既存在于社区内，也存在于社区之间，且与社会经济地位有关。远程医疗是一种可行的医疗保健提供方式，可能会影响少数民族和社会经济贫困社区个体的医疗服务可及性。可能需要进一步的政策或干预措施，以确保所有个体都能平等地获得新的医疗服务提供模式。
