Telemedicine reduces racial and economic inequities in access to hepatology care

ABSTRACT

Background: During the COVID-19 pandemic, telemedicine (TM) became an essential component of healthcare delivery to mitigate transmission of SARS-CoV-2. However, applications of TM to the field of Hepatology predate the COVID-19 pandemic, many of which were intended to increase access to care beyond subspecialized centers. We aimed to assess the impact of TM on access to Hepatology care within our healthcare network Methods: Utilizing ICD-10 codes, a retrospectively identified, prospectively followed cohort of patients with cirrhosis was compiled (n=407). Individual encounters were independently vetted through direct review of patient records by study personnel. Two cohorts were identified. The TM cohort (n=151) included encounters conducted via TM (audio or video) from 4/7/2020 - 6/7/2020. The face-to-face (F2F) cohort (n=333) included in-person clinic visits from 1/1/2019 - 6/1/2019;representing the standard of care prior to implementation of TM. Each cohort was followed for a total of 6 months from their index visit. Demographics, clinical metrics, and no-show (NS) rates were determined via chart review and use of the American Community Survey (data from the U.S. Census Bureau). NS rate was utilized as a surrogate for healthcare access. Results: The two cohorts were similar in composition, without statistically significant differences between race, mean income, insurance carrier, etiology of cirrhosis, or presence of decompensation (Table 1). NS rate was 13% in the F2F cohort vs. 4.5% in the TM cohort;a statistically significant decrease of 8.5% (p < 0.0001). The mean income estimate was significantly lower in patients with a NS in the F2F cohort (p = 0.04), but the mean income estimate was not significantly different in patients with NS in the TM cohort (p = 0.95). In the F2F cohort, Black patients were significantly more likely to NS than white patients (p = 0.001). However, black patients were less likely than white patients to NS in the TM cohort (p = 0.01). Conclusion: Overall NS rates significantly declined during the TM period, suggesting increased access to care facilitated by the implementation of TM. During the F2F period, Black patients and patients with lower income were more likely to NS to an appointment, suggesting potential barriers to attending F2F clinic visits. TM appeared to alleviate these barriers and increase access to Hepatology care in these populations.