ABSTRACT
Introduction: In response to the coronavirus disease 2019 (COVID-19) pandemic, hospitals nationwide opted to temporarily replace traditional in-person visits with telehealth visits. Unfortunately, due to socio-economic disparities, some groups may be at a disadvantage as a result of these changes. This observational study aimed to determine the temporal trends in demographic, socio-economic, and educational factors contributing to the disparities in access to health care during and after the lockdown. Methods: Due to the COVID-19 pandemic, a state of emergency was declared in Ohio between March 9th, 2020 and June 18th, 2020. The study cohort consisted of patients receiving outpatient care in the Cleveland Clinic Gastroenterology department during this period. To assess disparities, this group was compared to patients receiving care during the corresponding time periods in 2019 and 2021. The following variables were collected and compared between the three groups: demographics, substance abuse, education status, household income, insurance data, employment status, and type of visit (in person, virtual, or telephone). Chi-square test was used to compare categorical variables and student's t-test for continuous variables. A p value of <0.05 was considered statistically significant. SPSS software was used. Results: There were a total of 66,796 visits scheduled during the three study periods of which 19,764 patients had multiple visits. Only the first visit was considered for study purposes, thus yielding 47,032 visits. The mean age was 56.3 ± 17.6 years of which 36.9% were ³ 65 years. The cohort was predominantly female (61.9%), white (76.4%), and had private insurance (61.7%). The characteristics of patients seen in 2019, 2020, and 2021 are presented in table 1. Patients age ≥65 years, whites, those with Medicare insurance, non-English speakers and retired individuals sought healthcare less frequently during and after the pandemic. Women utilized healthcare more often than men before, during, and after the pandemic. There were also variations depending upon education level and median house hold income (table 1). The number of in-person visits rapidly declined during the pandemic, yet have not returned to pre-pandemic levels in 2021. The number of no shows/cancelled visits and tobacco, alcohol, and illicit drug use have steadily increased during and after the pandemic. Conclusion: There was reduced utilization of healthcare services during the COVID-19 pandemic among elderly, non-English speaking, retired, and less educated individuals;these negative effects persisted for elderly and non-English speaking individuals even after the lockdown was lifted. The continued increase in no show/cancellation rates and substance abuse is an alarming trend. Therefore, efforts should be targeted on improving healthcare access for these vulnerable groups.
ABSTRACT
Introduction: With the emergence of the COVID-19 pandemic, there was a dramatic increase in telehealth services in lieu of traditional in-person clinic visits throughout hospitals in the United States. Several factors such as patient demographics, socioeconomic factors, and access to internet/smart phones can impact the utilization of telehealth services. Therefore, we aimed to determine the influence of COVID-19 and social determinants of health on utilization of telehealth services. Methods: In response to the COVID-19 pandemic, a state of emergency was declared in Ohio on March 9th, 2020 and lifted on June 18th, 2020. The study population consisted of patients receiving outpatient care in the Cleveland Clinic Gastroenterology department during this lock-down period and representative samples from corresponding periods in 2019 before COVID-19 and in 2021 after the flattening of the COVID-19 surge. Telehealth visits were defined as those that involved real-time face-to-face video conferencing. All in-person visits and telephone only visits were classified as “other visits.” The following variables were collected and compared between the two groups: demographic data, substance abuse, insurance data and employment status. Education level and median household income were obtained from zipcode. Univariate and multivariable logistic regression analyses were performed to determine factors associated with utilization of telehealth visits. Results: During the COVID-19 lockdown in 2020, 11,999 patient visits were completed with 16,600 and 14,664 visits during respective time periods in 2019 and 2021, leading to a total of 43,263 visits. During the 2019, 2020, and 2021 study periods, the number of in-person visits were 16,577 (99.9%), 3,213 (26.8%) and 11,197 (76.4%) respectively;the number of virtual visits were 2 (0.01%), 2,743 (22.9%), 2,607 (17.8%);and the number of telephone visits were 21 (0.1%), 6,043 (50.4%) and 860 (5.9%). Telehealth visits were less frequently utilized in the following groups: older age, non-white race, Medicaid or other public insurance, higher education level, lower median household income, employed or retired status, and non-English-speaking status (Table 1). On multivariate analysis (Table 2), reduced utilization of telehealth was noted in older patients, those of the black or Hispanic race, higher education levels, those with Medicaid or other public insurance, unemployed individuals, and non-English/Spanish speakers. Conclusion: In spite of a dramatic increase in telehealth services during the COVID-19 pandemic, reduced utilization is observed in certain segments of population who might have additional barriers to health care. Further research is needed to study and determine the measures needed to overcome these barriers and optimize access to telehealth services as they continue to be utilized even after the pandemic.(Table Presented) Table 1: Univariate Analysis (Table Presented) Table 2: Multivariate Analysis