ABSTRACT
Introduction: In response to the COVID-19 pandemic, healthcare delivery systems evolved;we initially transitioned from in-person to telemedicine for outpatient clinics, and now into a mixed in-person/virtual environment. However, we do not know whether or how sociodemographic factors influence access to these services. These new systems may increase or decrease barriers to care, potentially leading to different challenges and sources of disparity in access to care. We aimed to investigate whether sociodemographic factors were associated with the rate of missed telehealth appointments. Methods: This single-institution retrospective cohort study included a sample of adult patients scheduled to visit the department's pancreaticobiliary surgeons via telehealth during the early phase of the pandemic (March- December 2020). We collected patients' sociodemographic factors, clinical characteristics, and whether they kept their appointment. Multivariable clustered logistic regression was performed to study the association between sociodemographic factors and keeping appointments, adjusting for clinical characteristics (diagnosis) and socioeconomic factors (distance from home to clinic, percentage of the studied population/tract classified as a minority — tract minority, and tract's income level). Results: 353 telehealth visits were included. Overall, 89.5% of the appointments were kept. Patients who had low education levels (OR:0.26;95%CI:0.09-0.76), were Black (OR:0.08;95%CI:0.03-0.23), male (OR:0.21;95%CI:0.07- 0.60) or non-English speaking (OR:0.04;95%CI:0.00-0.44) had lower odds of keeping appointments when compared to patients with high education levels, non-Hispanic white patients, females, and English speakers, respectively. There was a significant interaction between race/ethnicity and language. See Table 1 for cohort characteristics. Conclusion: After adjusted analysis, low education level, non-white or Hispanic race/ethnicity, male gender, and non-English language predicted missed telehealth appointments. A better understanding of how these factors influence access to telehealth, may help drive the subsequent development of interventions to mitigate this systems-based disparity. Further studies with a bigger sample size and designed as mixed methods may add to an understanding of the relationship between sociodemographic factors and access to virtual healthcare. (Table Presented)
ABSTRACT
Students and faculty alike found themselves in tumultuous times as they made the transition from face-to-face to remote learning. As faculty and administrators worked hard to overcommunicate with students in the hopes of keeping them engaged and focused on their academic pursuits, students found their attentions split among school, the Covid-19 health pandemic, and paying bills as many lost their employment. In some cases, the overcommunication led to students ignoring messages as they were completely overwhelmed;at the same time, some students found themselves reverting back to looking for the days of someone telling them what to do every minute of the day. Because faculty, and administrators, were not well prepared to handle the situation, an unevenness in how faculty communicated with students occurred. That is, some faculty withdrew in the same way that students did, and the term essentially ended with students turning in remaining assignments even though no further instruction occurred. Other faculty tried to move their face-to-face class online without taking into consideration the differences between these two channels. Still others tried to create an online course as they went from week to week. The inconsistencies across classes combined with the additional stress students were already experiencing became a recipe for exactly what the administration was trying to avoid-unsuccessful completion of courses and/or students unprepared for the courses that would come after the ones in which they were enrolled that term. The purpose of this study is to examine the experiences and perceptions of students when their classes pivoted from face-to-face to mediated, usually through video conferencing for synchronous or learning management systems for asynchronous. More specifically, we have collected qualitative data that addresses the communication students received from their instructors, what they believed instructors did successfully, what instructors could have done better, and the advice they would offer to instructors who found themselves in a similar crisis situation in the future.