Telehealth use during COVID-19 varied by specialty was rarer among low-income patients, study finds
• The use of telemedicine increased amid the coronavirus pandemic last year, based on patient demographics, medical needs, and clinical specialties. But the use was significantly lower in low-income areas, according to a new study of insured patients published in Health Issues.
• In the first months of the pandemic, more than 30% of all visits were made via virtual care and telemedicine visits increased 23 times per week compared to the previous COVID-19. However, the use of telemedicine was much lower in the poorest communities. The stakes for the lowest and highest quartiles of poverty rates were around 32% and 28%, respectively.
• The research also found specialties such as psychiatry, endocrinology, and neurology with the greatest use of virtual care and the least decrease in general visits. This was especially true compared to specialties like ophthalmology, which lost most of its volume to COVID-19 early on and had little use of telehealth.
The new findings show the scale of delayed care during the coronavirus pandemic. Although the use of telemedicine to connect patients to health has increased, the overall visit has been reduced by 35%. According to the study, general visits were analyzed from a database of nearly 17 million commercial and Medicare Advantage registered insurance databases and a database from January to Jun year.
Although the magnitude of the decline varied across clinical specialties and patient demographics, there has been a decrease in volumes in all segments of the health care system, including patients managing high-risk chronic diseases, which raised fears of a deterioration in health.
In comparison, a decrease in the volume of visits for low-risk respiratory conditions (such as bronchitis) is unlikely to affect the healthcare system, as social exclusion measures and other efforts to mitigate COVID- 19 reflect the lower transmission of the virus.
But overall, systems are likely to struggle to complete delayed care, the researchers said. The United States still faces COVID-19, although recently reported cases and deaths declined slightly in mid-January. According to this study, knowing how easy deferred care is will vary by specialty, as the uptake of telemedicine has varied based on special needs for physical exams or tests.
Across all fields of expertise, telemedicine use ranged from 68% of endocrinologists to only 9% of ophthalmologists. Eye clinics can face particular challenges when resuming delayed retinal care with virtual methods, as special equipment is needed for diagnostic exams.
By comparison, cognitive specialties like psychiatry rely less on physical examination and have seen the largest increase in telemedicine and the smallest decrease in the total number of visits. And chronic disease fell somewhere in between those two extremes, with conditions like high blood pressure and diabetes causing a sharp drop in healthcare volumes, tempered by a sharp increase in telemedicine use.
Following the findings, the researchers said health systems should allocate resources to reach patients with diseases who experienced the greatest decline in care, while also allocating greater clinical capacity and targeting people with chronic diseases towards the specialties with the greatest delay in late treatment management of the population on the move.
The study also found increased use of telemedicine among insured persons in wealthier countries with a greater minority presence among residents during the pandemic, placing a strong emphasis on existing inequalities in the US healthcare system.
The use of telemedicine and access to outpatient clinics during the pandemic was generally lower in rural areas than in urban ones. Only 24% of all treatments were performed virtually in rural areas, compared to 31% in urban areas. This may be due to lower broadband availability and is in line with the so-called "digital divide" in access to healthcare, according to the researchers.
The study did not analyze the incidence of audio-only telemedicine. Previous research shows that they are a valuable tool for low-income populations to access telemedicine without broadband or smartphones. However, another study published Tuesday in JAMA that examined telemedicine use at state-rated health centers in California from March to August found that low-income patients often only make audio visits.
During those months, 48.5% of all primary care visits were made by phone, compared to 48.1% in person and only 3.4% by video. Telephone visits peaked in April, representing 65.4% of all primary care visits.
However, the future of audio-only telehealth is unclear, as CMS has reported that reimbursement for phone calls will end after the COVID-19 public health emergency ends. Nixing's exclusive audio coverage is likely to disproportionately affect the low-income population and exacerbate the digital divide, the researchers warned.
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