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Disparities in Outpatient and Telehealth Visits During the COVID-19 Pandemic in a Large Integrated Health Care Organization: Retrospective Cohort Study.
Qian, Lei; Sy, Lina S; Hong, Vennis; Glenn, Sungching C; Ryan, Denison S; Morrissette, Kerresa; Jacobsen, Steven J; Xu, Stanley.
  • Qian L; Department of Research & Evaluation, Kaiser Permanente Southern California, Pasadena, CA, United States.
  • Sy LS; Department of Research & Evaluation, Kaiser Permanente Southern California, Pasadena, CA, United States.
  • Hong V; Department of Research & Evaluation, Kaiser Permanente Southern California, Pasadena, CA, United States.
  • Glenn SC; Department of Research & Evaluation, Kaiser Permanente Southern California, Pasadena, CA, United States.
  • Ryan DS; Department of Research & Evaluation, Kaiser Permanente Southern California, Pasadena, CA, United States.
  • Morrissette K; Department of Research & Evaluation, Kaiser Permanente Southern California, Pasadena, CA, United States.
  • Jacobsen SJ; Department of Research & Evaluation, Kaiser Permanente Southern California, Pasadena, CA, United States.
  • Xu S; Department of Research & Evaluation, Kaiser Permanente Southern California, Pasadena, CA, United States.
J Med Internet Res ; 23(9): e29959, 2021 09 01.
Article in English | MEDLINE | ID: covidwho-1381351
ABSTRACT

BACKGROUND:

Dramatic decreases in outpatient visits and sudden increases in telehealth visits were observed during the COVID-19 pandemic, but it was unclear whether these changes differed by patient demographics and socioeconomic status.

OBJECTIVE:

This study aimed to assess the impact of the pandemic on in-person outpatient and telehealth visits (telephone and video) by demographic characteristics and household income in a diverse population.

METHODS:

We calculated weekly rates of outpatient and telehealth visits by age, sex, race/ethnicity, and neighborhood-level median household income among members of Kaiser Permanente Southern California (KPSC) from January 5, 2020, to October 31, 2020, and the corresponding period in 2019. We estimated the percentage change in visit rates during the early pandemic period (March 22 to April 25, 2020) and the late pandemic period (October 4 to October 31, 2020) from the prepandemic period (January 5 to March 7, 2020) in Poisson regression models for each subgroup while adjusting for seasonality using 2019 data. We examined if the changes in visit rates differed by subgroups statistically by comparing their 95% CIs.

RESULTS:

Among 4.56 million KPSC members enrolled in January 2020, 15.0% (n=682,947) were ≥65 years old, 51.5% (n=2,345,020) were female, 39.4% (n=1,795,994) were Hispanic, and 7.7% (n=350,721) lived in an area of median household income telehealth visits during the pandemic varied across subgroups, while decreases in outpatient visits were similar, except by age. Among age groups, the ≥65 years population had the least increase in telehealth visits (236.6%, 95% CI 228.8%-244.5%), with 4.9 per one person-year during the early pandemic period versus 1.5 per one person-year during the prepandemic period. During the same periods, across racial/ethnic groups, Hispanic individuals had the largest increase in telehealth visits (295.5%, 95% CI 275.5%-316.5%). Across income levels, telehealth visits in the low-income group increased the most (313.5%, 95% CI 294.8%-333.1%). The rate of combined outpatient and telehealth visits in the Hispanic, non-Hispanic Black, and low-income groups returned to prepandemic levels by October 2020.

CONCLUSIONS:

The Hispanic group and low-income group had the largest percentage increase in telehealth utilization in response to the COVID-19 pandemic. The use of virtual care potentially mitigated the impact of the pandemic on health care utilization in these vulnerable populations.
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Full text: Available Collection: International databases Database: MEDLINE Main subject: Telemedicine / COVID-19 Type of study: Cohort study / Experimental Studies / Observational study / Prognostic study / Randomized controlled trials Limits: Aged / Female / Humans Language: English Journal: J Med Internet Res Journal subject: Medical Informatics Year: 2021 Document Type: Article Affiliation country: 29959

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Full text: Available Collection: International databases Database: MEDLINE Main subject: Telemedicine / COVID-19 Type of study: Cohort study / Experimental Studies / Observational study / Prognostic study / Randomized controlled trials Limits: Aged / Female / Humans Language: English Journal: J Med Internet Res Journal subject: Medical Informatics Year: 2021 Document Type: Article Affiliation country: 29959