RACIAL DISPARITIES IN PRIMARY CARE VIRTUAL VISITS DURING THE COVID-19 PANDEMIC

ABSTRACT

BACKGROUND: The COVID-19 pandemic led to a large increase in virtual care. Traditionally, E-visits (asynchronous provider evaluation via an online portal) and video visits (synchronous evaluation using real-time audio/video) have been utilized. However, there are racial, financial, and age-related disparities in home broadband access (Pew). During the pandemic, payers reimbursed telephone evaluation and management visits, increasing access to virtual care. However, barriers remained for patients without broadband access or video-enabled devices. We aim to assess racial disparity between black and white patients and whether age or socioeconomic status are associated with use of virtual visits. METHODS: A retrospective review was conducted of first-time visits with primary care providers from 3/1/20 to 6/30/20 at a large health system. Data was collected on type of visit, race, age, and area deprivation index (ADI).ADI ranks neighborhoods by socioeconomic status (SES) using census block groups based on income, house quality, employment, and education. Higher ADI is a marker of lower socioeconomic status (ADI of 10 is lowest SES, ADI of 1 is highest SES). RESULTS: 72153 unique patients were identified of whom 31037 (43%) received virtual care;13871 (19.2%) video, 14697 (20.3%) telephone (audio only), and 2469 (3.4%) E-visits. The mean age was 55.6 years, 32760 (45.4%) individuals identified as black, and 44784 (62.1%) were female. The average ADI was 5.23 (±3.17). Black patients had lower SES compared to white patients (6.96±2.93 vs 3.8±2.6). There was no difference in overall virtual care use rate between black and white patients (45.6% vs 45.2%, p=0.240). However, black patients were less likely to use E-visits (4.7% vs 6.4%, p=0.001), with no difference between telephone (26.5% vs 26.2%, p=0.298) or video visits (25.2% vs 25.3%, p=0.823). In multivariable logistic regression (Table 1), although black race was not significantly associated with virtual care use for primary care, age and SES did predict access to virtual care suggesting ages 18-29 and >65 and higher SES were less likely to utilize virtual care. CONCLUSIONS: During the first wave of the COVID-19 pandemic, black and white patients used virtual care at equal rates. However, there is a complex relationship between race, age and virtual care use. Further research is needed to examine the causal mechanisms.