SOCIODEMOGRAPHIC DETERMINANTS OF MISSED TELEHEALTH APPOINTMENTS IN HPB SURGERY
J. Christopher Polanco Santana*, Alessandra Storino, Mateo E. Garland, Mark P. Callery, Tara S. Kent
Surgery, Beth Israel Deaconess Medical Center, Boston, MA
Introduction: In response to the COVID-19 pandemic, healthcare delivery systems evolved; we initially transitioned from in-person to telemedicine for outpatient clinics, and now into a mixed in-person/virtual environment. However, we do not know whether or how sociodemographic factors influence access to these services. These new systems may increase or decrease barriers to care, potentially leading to different challenges and sources of disparity in access to care. We aimed to investigate whether sociodemographic factors were associated with the rate of missed telehealth appointments.
Methods: This single-institution retrospective cohort study included a sample of adult patients scheduled to visit the department's pancreaticobiliary surgeons via telehealth during the early phase of the pandemic (March-December 2020). We collected patients' sociodemographic factors, clinical characteristics, and whether they kept their appointment. Multivariable clustered logistic regression was performed to study the association between sociodemographic factors and keeping appointments, adjusting for clinical characteristics (diagnosis) and socioeconomic factors (distance from home to clinic, percentage of the studied population/tract classified as a minority — tract minority, and tract's income level).
Results: 353 telehealth visits were included. Overall, 89.5% of the appointments were kept. Patients who had low education levels (OR:0.26; 95%CI:0.09-0.76), were Black (OR:0.08; 95%CI:0.03-0.23), male (OR:0.21; 95%CI:0.07-0.60) or non-English speaking (OR:0.04; 95%CI:0.00-0.44) had lower odds of keeping appointments when compared to patients with high education levels, non-Hispanic white patients, females, and English speakers, respectively. There was a significant interaction between race/ethnicity and language. See Table 1 for cohort characteristics.
Conclusion: After adjusted analysis, low education level, non-white or Hispanic race/ethnicity, male gender, and non-English language predicted missed telehealth appointments. A better understanding of how these factors influence access to telehealth, may help drive the subsequent development of interventions to mitigate this systems-based disparity. Further studies with a bigger sample size and designed as mixed methods may add to an understanding of the relationship between sociodemographic factors and access to virtual healthcare.
Table 1. General Sample Characteristics Based on Missed Telehealth Appointment
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