Minorities, Socioeconomic Disadvantaged, and Older Patients have Decreased Utilization of Telehealth for Neurological Conditions
Marisa McGinley1, Tucker Harvey1, Allison Weathers1, Daniel Ontaneda1
1Cleveland Clinic
Objective:
To characterize telehealth utilization for neurological conditions and identify potential disparities in utilization.
Background:
Telehealth has the potential to improve access to neurological care, but there is a need to understand telehealth utilization to ensure equitable healthcare delivery.
Design/Methods:
All outpatient visits conducted by neurology clinicians at the Cleveland Clinic for patients ≥18 years from 7/2020 to 7/2022 were included. Patients with fully in-person care were compared to patients with a combination of telehealth and in-person care. Visits were analyzed using a generalized linear mixed effects model to predict telehealth or in person visit type, using fixed effects of age, race, ethnicity, gender, location, rural-urban commuting areas codes (RUCA), area deprivation index (ADI), insurance, provider, language, and visit completion, and random intercept of subjects. Significance was set at p<0.001.
Results:
192,556 patients (mean age 54.8 years, 59.4% female, 80.1% white, 3.4% Hispanic, 37.6% Medicare, mean visits 7.4 ) completed a total of 584,900 visits during the study timeframe. In-person visits were completed by older (57.8 vs 49.4 years), higher ADI (23.0% vs 20.3% 4th quartile), Black (12.3% vs 9.7%), Hispanic (3.2% vs 3.1%), male (41.2% vs 34.3%), local (72.2% vs 65.4%), metropolitan (85.8% vs 80.4%), and Medicare (45.5% vs 29.5%) individuals compared to telehealth visits. Odds of a visit being telehealth were significantly lower for older (OR 0.96), Black (OR 0.80), Hispanic (OR 0.79), higher ADI quartile (4th quartile OR 0.62), Medicaid (OR 0.77), Medicare (OR 0.80), self-pay (0.48), micropolitan (OR 0.83), and non-English primary language (OR 0.35) patients.
Conclusions:
The COVID-19 pandemic expanded access to telehealth care, but disparities remain in utilization most notable for older, Black, Hispanic, and lower socioeconomic status individuals. Efforts are needed to understand patient barriers and preferences to telehealth along with legislation needed to facilitate equitable healthcare delivery.