Gordon Nancy P, Lin Teresa Y, Torreblanca Antonia, Reed Mary E
Division of Research, Kaiser Permanente Northern California, 4480 Hacienda Drive, Pleasanton, Oakland, CA, 94588, USA.
The Permanente Medical Group, Oakland, CA, USA.
BMC Health Serv Res. 2024 Aug 7;24(1):900. doi: 10.1186/s12913-024-11356-7.
During the first nine months of the COVID-19 emergency, patients were encouraged to use virtual versus clinic visits if in-person care was not deemed necessary by clinical staff. This study examined the association of spoken language preference and ethnicity with use of video versus phone virtual visits by US Latino and Chinese adult patients who got care in the same healthcare system.
We analyzed electronic health record data for four groups of adults aged 26-85y who had ≥ 1 primary or specialty care outpatient clinician visits during April-December 2020: 80,869 Latino adults preferring Spanish (LEP Latino); 214,765 Latino adults preferring English (non-LEP Latino); 23,430 Chinese adults preferring a Chinese dialect (LEP Chinese); and 49,710 Chinese adults preferring English (non-LEP Chinese). Prevalence of the following utilization outcomes were compared by language preference (LEP/non-LEP) within ethnicity and by ethnicity within language preference for four age subgroups (26-39y, 40-64y, 65-75y, and 76-85y): ≥ 1 virtual (video or phone) visit, ≥ 1 video visit, ≥ 1 phone visit, ≥ 1 clinic visit, video visits only, and phone visits only. We also compared ethnicity x language group differences within age subgroups using absolute difference and adjusted prevalence ratios derived from modified log-Poisson regression models that controlled for age and sex.
Among virtual users, LEP Latino and Chinese adults were significantly less likely to use video visits and more likely to use phone visits than non-LEP Latino and Chinese adults in the same age strata. The LEP/non-LEP difference in video visit use was significantly larger among Latino than Chinese patients, with no similar ethnic group difference observed for phone visits. Within the LEP and non-LEP language groups, Chinese adults were significantly more likely than Latino adults to use video visits and less likely to use phone visits.
During the first nine months of the COVID-19 pandemic, uptake of video and phone virtual visits by Latino and Chinese adults significantly differed by LEP/non-LEP status within ethnicity and by ethnicity within LEP/non-LEP language group. These findings underscore the importance of disaggregating data by ethnicity and language preference when attempting to understand and study patient use of different virtual visit modalities.
在新冠疫情紧急状态的前九个月，如果临床工作人员认为非必要，鼓励患者进行虚拟就诊而非门诊就诊。本研究调查了美国拉丁裔和华裔成年患者的语言偏好和种族与视频就诊和电话虚拟就诊使用情况之间的关联，这些患者在同一医疗系统接受治疗。
我们分析了四组年龄在26 - 85岁之间的成年患者的电子健康记录数据，这些患者在2020年4月至12月期间至少有1次初级或专科门诊临床医生就诊：80869名偏好西班牙语的拉丁裔成年人（拉丁裔有限英语能力者）；214765名偏好英语的拉丁裔成年人（非拉丁裔有限英语能力者）；23430名偏好方言的华裔成年人（华裔有限英语能力者）；以及49710名偏好英语的华裔成年人（非华裔有限英语能力者）。按种族内的语言偏好（有限英语能力者/非有限英语能力者）以及按语言偏好内的种族，对四个年龄亚组（26 - 39岁、40 - 64岁、65 - 75岁和76 - 85岁）的以下使用结果的患病率进行了比较：至少1次虚拟（视频或电话）就诊、至少1次视频就诊、至少1次电话就诊、至少1次门诊就诊、仅视频就诊以及仅电话就诊。我们还使用绝对差异和调整后的患病率比比较了年龄亚组内的种族×语言组差异，这些比值来自控制了年龄和性别的修正对数泊松回归模型。
在虚拟就诊用户中，与同一年龄层的非拉丁裔有限英语能力者和华裔非有限英语能力者相比，拉丁裔有限英语能力者和华裔有限英语能力者使用视频就诊的可能性显著更低，而使用电话就诊的可能性更高。拉丁裔患者中视频就诊使用方面的有限英语能力者/非有限英语能力者差异比华裔患者显著更大，电话就诊方面未观察到类似的种族差异。在有限英语能力者和非有限英语能力者语言组中，华裔成年人比拉丁裔成年人使用视频就诊的可能性显著更高，而使用电话就诊的可能性更低。
在新冠疫情的前九个月，拉丁裔和华裔成年人对视频和电话虚拟就诊的接受情况在种族内按有限英语能力者/非有限英语能力者状态以及在有限英语能力者/非有限英语能力者语言组内按种族存在显著差异。这些发现强调了在试图理解和研究患者对不同虚拟就诊方式的使用情况时，按种族和语言偏好对数据进行分类的重要性。
