The Digital Divide in Pediatric Gastroenterology

ABSTRACT

Background: The utilization and reimbursement of technology-based health care services has drastically increased, especially in the era of COVID-19. However, they are not universally accessible and are disproportionately utilized, which can exacerbate already existing disparities Objective: To evaluate differences in technology-based health care usage in an academic pediatric gastroenterology practice based on demographic characteristics and the Area Deprivation Index (ADI), a validated composite index of socioeconomic status (SES). Design/Methods: We conducted a retrospective cohort study of new patients seen in the Pediatric Gastroenterology Clinic at the Children's Hospital Colorado for constipation from 1/1/2019-12/31/2020. Demographic variables and number of secure messages, telephone calls, telehealth visits, and emergency department (ED) visits for constipation were extracted for up to one year. We assigned each patient a state and national ADI based on home address. Univariate negative binomial regression models were used to determine significance. We also used a Poisson regression model to better understand the interplay between ED visits, technology-based health care usage, and SES. Result(s) 2087 patients were included in our study. The predicted mean number of patient-initiated secure messages (P=0.04) and phone calls (P=0.03) were significantly less in those with lower socioeconomic status (higher state ADI) (Figure 1). Socioeconomic status based on both state and national ADI did not significantly affect telehealth video usage. The predicted mean number of telehealth video visits and patient-initiated secure messages were significantly lower in Hispanic patients (P<0.001 and P<0.001), non-English speakers (P<0.001 and P<0.001), and those with government insurance (P=0.02 and P<0.001) (Table 1). The predicted mean number of patient-initiated phone calls was also significantly lower in Non-English speakers (P=0.02). The Poisson regression model showed that when the number of patient-initiated secure messages and telephone calls is small, lower SES is associated with more ED visits. As the number of patient-initiated secure messages and telephone calls increase, the extent of the positive association between low SES and ED visits attenuated gradually and eventually became negatively associated (P=0.04 and P=<0.001). This relationship was not significant for telehealth video visits. Conclusion(s) Patients with lower socioeconomic status, non-English speakers, and Hispanic patients utilize technology-based health care services significantly less. Thus, while technology-based health care services may help to increase access to care for some patients, it is important to minimize barriers and prevent the worsening of already-existing inequities in health care access. Improving access to secure messaging and telephone calls in patients with low SES may help to prevent constipation-related ED visits as well as reduce healthcare costs.