Improved Outpatient Medical Visit Compliance with Sociodemographic Discrepancies in Vascular Telehealth Evaluations.

ABSTRACT

OBJECTIVE: The coronavirus pandemic has led to a rapid expansion in telemedicine across all medical fields but has also exposed tele-healthcare disparities with differing access to technology across racial and ethnic groups. The objective of our study was to investigate the impact of telehealth on vascular visit compliance and to explore the effect of sociodemographic factors on vascular surgery outpatient telehealth utilization during the COVID-19 pandemic. METHODS: Consecutive patients undergoing outpatient vascular surgery evaluation between February 24, 2020 (the launch of our telemedicine program) and December 31, 2020, were reviewed. Baseline demographic and outcomes were obtained from the electronic medical record. Telehealth or in-person evaluations were defined according to the patient's index visit during this period. Medical visit compliance was established upon completion of the telehealth or in-person encounter. Chi square tests and logistic regression analyses were used. RESULTS: There were 23,553 scheduled outpatient visits for 10,587 patients during the study period. 1,559 of those were scheduled telehealth encounters compared to 21,994 scheduled in-persons encounters. Out of the total scheduled outpatient encounters, 13,900 medical visits (59.0%) were completed 1,183 telehealth visits and 12,717 in-person visits. The mean travel distance saved for telehealth visits were 22.1±27.1 miles and the mean travel time saved was 46.3±41.47 minutes. We noted no sociodemographic differences between patients scheduled for telehealth vs. in-person visits. There was a trend towards a lower proportion of African American patients among the telehealth group vs. in-person group (7.8% vs. 10.6%, P=.116) respectively; however, this did not reach statistical significance. There was a significantly higher rate of medical visit completion among the telehealth group compared to the in-person group (79.5% vs. 59.4%, P<.001). Among patients who were scheduled for an outpatient medical visit, having a scheduled telemedicine evaluation (vs. in-person) was associated with 2.3 times the odds of completing the medical visit (Odds Ratio (OR)=2.31, 95% Confidence Interval (CI) 2.05-2.61) adjusting for age, sex, race, ethnicity, language and the distance between the patient's home zip code and the outpatient vascular center zip code. Selecting for scheduled telemedicine visits, African American patients were associated with decreased odds of telemedicine utilization (OR=0.73, 95%CI0.59-0.90) after adjusting for age, sex, ethnicity, language and visit type. CONCLUSIONS: The vascular surgery outpatient telehealth evaluation appears to improve medical visit completion in our region with apparent sociodemographic disparities. Further studies are needed to confirm if telemedicine expansion has improved access to care in other geographical areas.