Telemedicine disparities during COVID-19: Provider offering and individual technology availability.

Abstract

The COVID-19 pandemic has once again highlighted the racial disparities in health-related outcomes.1 Since the beginning of the COVID-19 pandemic, visits to primary care physicians (PCPs), and outpatient specialist visits have declined as many hospitals have postponed or canceled elective procedures.2 These gaps in care have been felt particularly hard by people of color and those from the lower end of the socioeconomic spectrum.3 While the proportion of physicians using telemedicine during the pandemic has dramatically increased, disparities appear to exist in the availability and use of telemedicine technologies.4 We examined receipt of routine check-ups and preventative care among Medicare beneficiaries during the pandemic to determine provider and patient barriers to the use of telemedicine technologies. Data for this study were drawn from the COVID-19 Summer and Fall 2020 Rapid Response Supplements to the Medicare Current Beneficiary Survey (MCBS) Public Use Files originally created by the Centers for Medicare & Medicaid Services Office of Enterprise Data and Analytics.5 The COVID-19 Supplement was developed to assist researchers in analysis on health disparities, access to and satisfaction with routine and primary care, and telemedicine use during the pandemic. Using data from the MCBS Supplement, descriptive sample statistics were computed across four racial/ethnic groups—blacks, whites, Hispanics, and other races. Racial groups were compared along dimensions of availability of telemedicine and receipt of care before and during the COVID-19 pandemic. To estimate the magnitude of differences between the racial groups, an ordered logistic model was regressed controlling for income, gender, region of residence, and metropolitan status. Before the COVID-19 pandemic, about 25% of Medicare beneficiaries reported that their provider offered telemedicine. Offerings of telemedicine differed by race though differences were not statistically significant. During the COVID-19 pandemic, availability increased among all groups from 25% to 50%–60% of all respondents reporting that their PCP offered telemedicine appointments—a statistically significant difference (Figure 1). Compared with other racial groups, Blacks experienced the lowest rate of increase in telemedicine availability during the pandemic (χ2 = 11.9935, p = 0.007). Despite a larger proportion of PCPs offering telemedicine, blacks were less likely than other groups to have the necessary computers (χ2 = 1323.4128, p < 0.001), smartphones (χ2 = 200.5089, p < 0.001), and/or tablets (χ2 = 421.9582, p < 0.001) available in their households. In fact, 82.2% of whites own at least one technological device compared with only 57.4%, 56.2%, and 75.5% of blacks, Hispanics, and other racial groups respectively (χ2 = 1026.9451, p < 0.001). Being black (odds ratio [OR] = 0.529; confidence interval [CI] = 0.473, 0.592) or Hispanic (OR = 0.440; CI = 0.397, 0.487) was significantly correlated with lower technological availability. Furthermore, being black (OR = 1.417; CI = 1.135, 1.768) or Hispanics (OR = 1.330; CI = 1.104, 1.602) was correlated with a lower rate of preventative and routine care. These groups displayed significantly higher odds of having been unable to receive preventative or routine care during the pandemic. Results could be related to their lack of technological availability. Despite the increase in the number of PCPs offering telemedicine during the pandemic, racial disparities exist in both the number of beneficiaries with PCPs offering telemedicine and the number of beneficiaries with technologies needed for telemedicine use. Racial disparities in the use of telemedicine during the pandemic have been previously reported4 and may be relate to a combination of provider utilization and patient availability of necessary technology. A recent report from the Pew Research Center indicated that some aspects of racial differences in telemedicine use are associated with disparities in income and internet availability which is more prevalent among whites compared with blacks and Hispanics.6 This digital divide appears to transcend both racial and socioeconomic lines resulting in lower prevalence in access among blacks and Hispanics. Interestingly, a study by Campos-Castillo indicated that while those blacks with internet access were more likely to post COVID-19 related information on social media, this information does not appear to translate into improved access to care or health outcomes.7 It is possible that other unmeasured factors may have contributed to the observed disparities in telehealth use including education, sex/gender, and residence. Additional research is needed to identify strategies designed to reduce the gaps in both patient access to technologies and providers offering telehealth options. Greater education, outreach, and infrastructure could be required. Given that internet access plays a key role in identifying locations for vaccine distribution, appointments for vaccination and patients' progress through dosing regimens, understanding these issues underscores U.S.'s plan to fast-track vaccine distribution and meet President Joe Biden's goal of 200 million COVID-19 vaccination shots being distributed within his first 100 days in office.8 The authors have no real or potential conflict of interest related to this work. Both authors were engaged in and take responsibility for the study's concept and design, acquisition of data, analysis and interpretation of data, and preparation of manuscript. There were no sponsors involved in this project.