IMPACT OF COVID-19 PANDEMIC AND SOCIAL DETERMINANTS OF HEALTH ON UTILIZATION OF TELEHEALTH SERVICES

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: