INEQUITY EXISTS IN TELEMEDICINE USE DURING THE COVID-19 PANDEMIC FOR GASTROINTESTINAL SURGERY PATIENTS IN THE DEEP SOUTH
Connie Shao*, Chandler McLeod, Sushanth Reddy, Lauren Theiss, Isabel Marques, Karin M. Hardiman, Gregory D. Kennedy, Drew J. Gunnells, Robert H. Hollis, Jamie A. Cannon, Melanie S. Morris, Daniel I. Chu
Surgery, The University of Alabama at Birmingham, Birmingham, AL
Introduction: Telemedicine is designed to increase healthcare access and is increasingly used during the COVID-19 pandemic. However, its use among historically vulnerable populations is poorly characterized and may further exacerbate healthcare disparities. We aimed to characterize telemedicine use among a diverse surgical population in the Deep South during the COVID-19 pandemic.
Methods: All patients seen in gastrointestinal (GI) surgery clinics at a tertiary care academic center in Alabama were reviewed from March 18, 2020 to September 30, 2020. Demographics including age, race, sex, insurance, date of service, and home ZIP code were recorded. Internet availability according to the FCC and median income of home ZIP codes were recorded. Patients were stratified by clinic visit type (in-person versus telemedicine, and within telemedicine, phone versus video) and compared by socioecological factors. Chi-square and ANOVA tests were performed to compare patient groups and logistic regression was used to predict telemedicine use.
Results: Of the 2,580 GI surgery patients seen, 50.5% (n=1,302) were in-person and 49.5% (n=1,278) were via telemedicine, including video (43.4%) and phone (56.6%) visits. Patients were predominantly female (59.3%) and white (62.1%), with private insurance (53.8%) and a mean age of 52.1 years. Patients seen in-person and via telemedicine were similar except patients using telemedicine lived further from the hospital (mean distance 60.6 mi vs 49.6 mi, p<0.001). Living 100 mi or more from the hospital and in a ZIP code with the highest quintile of median income were independent predictors of telemedicine use (OR 1.51, 95% CI 1.16-1.97; OR 1.39, 95% CI 1.04-1.85, respectively).
Among patients who used telemedicine, those with phone use were more likely to be Black compared to those with video use (35.3%, vs 29.4%, p=0.043). Patients with phone use were older (mean age = 54.0 yr vs 50.5 yr, p<0.001) and came from ZIP codes with lower median income ($35,618 vs $37,846, p=0.037). They were more likely to have Medicaid (10.7% vs 6.1%) or Medicare (32.1% vs 25.0%) and less likely to be privately insured (50.5% vs 60.2%) compared to patients with video use (p=0.001). Living 100 mi or more from the hospital was an independent predictor of video use (OR 2.27, 95% CI 1.56-3.30). Having Medicaid and age greater than 80 were independent predictors of phone use (OR 0.46, 95% CI 0.29-0.73; OR 0.37, 95% CI 0.16-0.86, respectively).
Conclusion: Patients who live further from the hospital are more likely to use telemedicine. Phone visits are used more by patients who are Black, older, from lower income ZIP codes, publicly insured, and live closer to the hospital. Variations in patient telemedicine use exist across a diverse surgical population in the Deep South, suggesting telemedicine be tailored to patient preferences and available resources.
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