JMIR Publications

ABSTRACT

Background:

The COVID-19 pandemic resulted in rapid change in how patient care was provided, particularly through the expansion of telehealth and audio-only phone-based care.

Objective:

The goal of this study was to evaluate inequities in video and audio-only care during various time points including the initial wave of the COVID-19 pandemic, later stages of the pandemic, and an historical control. We sought to understand the characteristics of care during this time for a variety of different groups of patients that may experience healthcare inequities.

Methods:

We conducted a retrospective analysis of electronic health record (EHR) data from encounters from 34 family medicine and internal medicine primary care clinics in a large, Midwestern health system, using a repeated cross-sectional observational study design. These data include patient demographic data, as well as encounter, diagnosis, and procedure records. Data were obtained for all in-person and telehealth encounters (including audio-only phone-based care), which occurred during 3 separate time periods; an initial COVID-19 period (T2: 03/16/2020-05/3/2020), a later COVID-19 period (T3: 05/4/2020-09/30/2020), and an historical control period from the previous year (T1: 03/16/2019-09/30/2019). Primary analysis focused on the status of each encounter, in terms of whether it was completed as scheduled, cancelled, or where the patient missed the appointment. A secondary analysis was performed to evaluate the likelihood of an encounter being completed based on visit modality (phone, video, in-person).

Results:

In total, there were 938,040 scheduled encounters during the three time periods, with 178,747 unique patients, that were included for analysis. Patients with completed encounters were more likely to be younger than 65 years old (71.8%-74.1%), female (58.8%-61.8%), White (75.6%-76.7%), and have no significant comorbidities (63.2%-66.8%) or disabilities (53.2%-61.1%) in all time periods than those who had only cancelled or missed encounters. Effects on different subpopulations are discussed herein.

Conclusions:

Findings from this study demonstrate that primary care utilization across delivery modalities (in person, video, and phone) was not equivalent across all groups before and during the COVID-19 pandemic, and different groups were differentially impacted at different points. Understanding how different groups of patients responded to these rapid changes, and how healthcare inequities may have been affected, is an important step in better understanding implementation strategies for digital solutions in the future.