Telemedicine Equity in the Ambulatory Cardiology Population

From the 2023 HVPA National Conference

Colin Wu, Undergraduate (Johns Hopkins School of Medicine), Lochan Shah, Postgraduate, Helen Hughes, Postgraduate, Nisha Gilotra, Postgraduate,  Sean Tackett, Postgraduate, Lily Sadauskas, Postgraduate

Background:
Since the COVID-19 pandemic, there has been a significant increase in the number of telemedicine encounters. As telemedicine has risen in popularity, it has been celebrated for its potential to make healthcare more accessible and reduce disparities. However, there is limited data exploring if telemedicine is delivering on its promise—if it is mitigating or instead exacerbating health disparities.

Objective:
This study analyzed telemedicine modality utilization (video visits, which was defined as the positive outcome vs. incomplete/phone visits, which was defined as the adverse outcomes) and investigated differences by various sociodemographic factors.

Methods:
Patient telemedicine data between January 1, 2020, to December 1, 2021, were collected from a large academic institution’s Telemedicine Equity Dashboard located in Maryland. This dashboard shows deidentified sociodemographic factors from telemedicine encounters and is divided into video and incomplete/phone visits. Note that incomplete/phone visits encapsulated all phone visits and any incomplete video visits. Descriptive and temporal analyses were conducted. Telemedicine modality utilization was stratified by age, sex, race, ethnicity, primary payor, preferred language, and social deprivation index.

Results:
From January 2020 to December 2021, there were 47,961 cardiology telemedicine encounters. Most patients only had one encounter with few patients having multiple encounters. From the descriptive analysis, 79.63% of the total encounters were video visits while 20.37% were incomplete/phone visits. Patients in telemedicine encounters were predominantly White, with either Medicare or private insurance, and with English as their preferred language. Over time, from January 2020 to December 2021, the rate of conversion to phone/incomplete video visits decreased from 44% to 8%. Older patients had consistently higher rates of conversion to phone/incomplete video visits, with the worst outcomes in patients age 75+.

Conclusions:
In this cross-sectional study that looked at telemedicine modality utilization among cardiology patients, disproportionate rates of incomplete/phone visits were found. Certain sociodemographic factors such as age predisposed patients to a greater likelihood of having an incomplete/phone telemedicine visit. These disparities may be due in part to poor digital health literacy, which necessitates further study.

Clinical Implications:
Telemedicine has the potential to increase access to healthcare. However, as demonstrated by this study, telemedicine may disproportionately exacerbate health inequities because elderly patients—who stand to benefit significantly from telemedicine due to transportation barriers and mobility challenges—are disproportionately unable to complete video visits as scheduled. As a result, for providers to continue to provide high-quality care, there must be increased efforts to spread digital health literacy with the goal of improving utilization rates of video visits.

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