TELEMEDICINE CREATES HEALTH DISPARITIES IN AN AMBULATORY GASTROENTEROLOGY PRACTICE: A SINGLE-CENTER RETROSPECTIVE ANALYSIS

ABSTRACT

Background: The COVID-19 pandemic has allowed for the rapid expansion of telemedicine to continue to provide patients access to medical care while minimizing in-person contact. Studies have suggested that telemedicine may worsen healthcare disparities in certain segments of the population, driven in part by lack of access to appropriate technology or poor technological literacy. The aim of this study was to determine the impact of telemedicine on clinic no-show rates in the ambulatory gastroenterology setting. Methods: Single-center retrospective study of no-show visits for ambulatory in person (IP) and Telemedicine clinic appointments comparing the 15 months pre-pandemic to the first 15 months of the pandemic using an administrative database. The pre-pandemic cohort (PPC) was from January 1, 2019 to March 15, 2020 and the pandemic cohort (PC) was from March 16, 2020 to June 1, 2021. Race/ethnicity and preferred language were self-reported by patients during registration. Insurance types were categorized into private or public insurance. Statistical analysis was performed using descriptive statistics and univariate analysis. Results: There were 1841 no-show visits during the study period, 963 (52.3%) of which were PPC and 888 (48.2%) PC. In the PPC, 62.5% of these no-show visits were IP, whereas 86.8% were VV during the pandemic. The overall no-show rate decreased during the pandemic from 9.8% to 6.9% (p <0.0001). The no-show rate decreased in the PPC amongst Black (11.9 vs 8.6;p = 0.002) and Non-Hispanic White (53.8 vs 48.3, p=0.018) patients, but increased in Asian patients (8.2% vs 11.9%, p=0.007). There was a decrease in the proportion of no-show new patient appointments during the pandemic (28.2 vs 18.4, p <0.0001) along with telephone visits (22.5 vs 10.5, p<0.0001). Age >60 (OR 0.8, 95% CI 0.69-0.91, p=0.002), Hispanic ethnicity (OR 0.55, CI 0.46-0.66, p<0.00001), non-English speaking (OR 0.62, CI 0.47-0.83, p= 0.001), and follow-up appointments (OR 0.34, CI 0.28-0.4, p<0.00001) were associated with lower odds of showing up for an appointment during the pandemic period. Conclusion: When utilizing telemedicine as the primary modality for ambulatory clinic visits, there was an overall decrease in the proportion of no-show appointments during the pandemic. No show rates were improved for Black and non-Hispanic white patients but worsened for Asian patients. Elderly, Hispanic ethnicity and non-English speaking patients were also at higher risk of no-show visits during the pandemic. Future studies should aim to identify the risk factors within these populations that can be modified to improve access to healthcare. (Table Presented)