Telemedicine has Expanded Access to Care Amid COVID-19 Pandemic, but Health Disparities Remain

The COVID-19 pandemic has fundamentally altered the way patients access healthcare. The pandemic has also highlighted ongoing disparities in health care, and how a lack of digital literacy and access to technology can be a real hinderance to receiving optimal treatment. Researchers from the Boston area sought to investigate how specific demographic disparities in the use of telemedicine compared with in-person surgical consultations after the initial wave of COVID. The findings of their analysis were published in the Journal of the American College of Surgeons.

This retrospective analysis took place within the division of general and gastrointestinal surgery at an academic medical center between March 24 and June 23, 2020 (Phase I), and June 24 through December 31, 2020 (Phase II). March 24, 2020 represents the date an emergency order was issued by the Massachusetts state governor, which mandated the closure of non-essential businesses and organizations, which also meant the halting of all non-emergency surgeries. On June 24, 2020, Massachusetts issued reopening guidelines, and resumed non-essential elective surgical procedures.

The study consisted of 4,908 patients across both phases. In Phase I, 347 in-person and 637 virtual visits were completed. While this phase of the analysis found no discernible differences in virtual compared to in-person visits among demographics, it revealed that among patients using telemedicine, Latino/Hispanic patients were less likely to have video compared with audio-only visits than their white counterparts.

During Phase II, there was a notable increase in in-person visits (up to 2,922), and 1,001 virtual visits. According to the researchers, no significant differences were observed across insurance types; however, Black patients were more likely to have virtual visits than white patients. The study found that overall, lower education level, and non-English as a primary language were associated with decreased video use.

“The surge in telemedicine has focused attention on the digital divide and highlighted the limited ability of vulnerable populations to access and use telemedicine,” said lead author Gezzer Ortega, MD, MPH, lead faculty for Research and Innovation for Equitable Surgical Care, Center for Surgery and Public Health, and adjunct faculty, Patient-Reported Outcomes, Value and Experience Center at Brigham and Women’s Hospital, Boston, Massachusetts via a press release.

“It’s really interesting to sit here in January 2022 and analyze data on virtual care where about two years ago, we hardly ever used virtual care,” said study coauthor Ali Tavakkoli, MD, chief of the division of general and gastrointestinal surgery at Brigham and Women’s Hospital. “The first wave of COVID pushed us to implement this path and format of care where we thought it would not be possible. Now the data, including this study, show that it can be done, and it can be done safely. During the current wave of COVID where we’ve become heavily dependent on virtual visits again, it’s great to have this data to show how we’re doing with this format.”