Veronica Rivera|Melissa Aldridge|Katherine Ornstein|Kate Moody|Audrey Chun
RESEARCHRacial and Socioeconomic Disparities in Access to Telehealth
Icahn School of Medicine at Mount Sinai|Icahn School of Medicine at Mount Sinai|Icahn School of Medicine at Mount Sinai|Icahn School of Medicine at Mount Sinai|Icahn School of Medicine at Mount Sinai
journal american geriatrics societyvolume 69 issue 1 p 4445 letter editorfree access researchracial socioeconomic disparities access telehealth veronica rivera md department geriatrics palliative medicine icahn school medicine mount sinai new york new york usasearch papers authormelissa aldridge phd corresponding author melissaaldridgemssmedu profaldridge department geriatrics palliative medicine icahn school medicine mount sinai new york new york usasearch papers authorkatherine ornstein phd department geriatrics palliative medicine icahn school medicine mount sinai new york new york usasearch papers authorkate moody bs department geriatrics palliative medicine icahn school medicine mount sinai new york new york usasearch papers authoraudrey chun md department geriatrics palliative medicine icahn school medicine mount sinai new york new york usasearch papers author veronica rivera md department geriatrics palliative medicine icahn school medicine mount sinai new york new york usasearch papers authormelissa aldridge phd corresponding author melissaaldridgemssmedu profaldridge department geriatrics palliative medicine icahn school medicine mount sinai new york new york usasearch papers authorkatherine ornstein phd department geriatrics palliative medicine icahn school medicine mount sinai new york new york usasearch papers authorkate moody bs department geriatrics palliative medicine icahn school medicine mount sinai new york new york usasearch papers authoraudrey chun md department geriatrics palliative medicine icahn school medicine mount sinai new york new york usasearch papers author first published 19 october 2020 httpsdoiorg101111jgs16904citations 2aboutsectionspdf toolsrequest permissionexport citationadd favoritestrack citation shareshare give accessshare full text accessshare fulltext accessplease review terms conditions use check box share fulltext version articlei read accept wiley online library terms conditions useshareable linkuse link share fulltext version article friends colleagues learn morecopy url share linkshare onemailfacebooktwitterlinked inredditwechat rapid implementation telehealth become hallmark healthcare systems response covid19 pandemic telehealth demonstrated feasibility efficacy care older adults including vulnerable homebound populations1 2 implementation telehealth facilitated relaxation health insurance portability accountability act 1996 hipaa allowing use nonhipaacompliant platforms video visits well temporary increase reimbursement rates telehealth medicare medicaid patients3 4 however emerging evidence suggests minority populations face substantial barriers telehealth including lack familiarity technology lower health digital literacy sensory impairments lack broadband access lack assistance510 given widespread implementation telehealth tool provide ongoing care older adults pandemic crucial understand whether access use telehealth services differed disadvantaged groups including racialethnic minorities methods conducted crosssectional analysis electronic medical records large urban geriatric outpatient practice covid19 surge new york city nyc outpatient practice provides primary consultative care highrisk highneed vulnerable complex older adults many advanced illness sample consisted active patients defined visit within 19 months march 1 2020 analyses patient visit data included video telephone visits completed peak covid19 cases nyc march 18 2020 may 15 2020 examine access telehealth services measured whether patient proxy activated patient online portal mychart within electronic medical record required telehealth use start study period activation requires access mobile device computer internet access may occur either onsite healthcare providers home estimated multivariable logistic regression model examine associations patient characteristics activation status subset patients activated patient online portal study period visit study period estimated multivariable logistic regression model examine associations patient characteristics video versus telephone telehealth visit study approved mount sinai institutional review board results 4571 total patients onethird 351 aged 80 younger 210 aged 90 older 70 female 738 557 white 188 eligible medicaid total 2438 533 activated online portal thus potential telehealth video visit overall 1651 361 activated portal 482 198 declined activating portal patients activated portal likely younger white male english speaking married partnered dementia table 1 table 1 characteristics geriatric patient population telehealth patient online portal activation total activated activated declined aor 95ci n 4571 n 2438 n 1651 n 482 n age 80 1606 351 612 302 87 reference 8089 2006 439 518 373 108 68 5978 90 959 210 434 435 131 50 4260 sex female 3371 738 518 377 106 reference male 1200 263 578 318 105 100 86116 race white 2547 557 607 306 87 reference african american 563 123 401 464 135 51 4262 asian 128 28 680 227 94 135 90202 1100 241 446 419 135 61 5273 unknown 233 51 378 515 107 43 3258 english language yes 4145 914 545 355 100 reference 388 86 405 430 165 79 61101 medicaid coverage yes 860 188 408 448 144 74 6290 3711 812 562 341 97 reference marital status marriedlife partner 1433 313 652 266 82 160 138186 widoweddivorcedsingle 3138 686 485 398 117 reference dementia yes 728 159 463 426 111 90 76108 3843 841 547 349 104 reference note p value 001 race category includes american indianalaskan native 09 native hawaiianpacific islander 07 abbreviations aor adjusted odds ratio compares activated activateddeclined ci confidence interval adjusted analyses patients less likely activated portal older adjusted odds ratio aor 68 95 confidence interval ci 5978 aged 8089 vs 80 aor 50 95 ci 4260 aged 90 older vs 80 african american compared white aor 51 95 ci 4262 eligible medicaid aor 74 95 ci 6290 patients marriedpartnered higher likelihood activation without spousepartner aor 160 95 ci 138186 among patients activated portal n 2438 sought care study period n 651 statistically significant differences likelihood telehealth video versus telephone visit unadjusted adjusted models discussion found substantial differences race socioeconomic status access telehealth video services covid19 surge nyc africanamerican patients races significantly less likely white patients activated online portal likely declined activation outright independent race eligible medicaid also less likely activated portal however activation online portal considered differences demographic socioeconomic characteristics likelihood receiving telehealth video visit relative telephone visit covid19 surge nyc underscoring key role access telehealth technology patients ability access telehealth assessed facilitated part intake appointment telehealth becomes embedded clinical practice emergency standard clinical care critical ensure use exacerbate healthcare disparities among vulnerable older adults acknowledgments conflict interest melissa aldridge funded grant k07ag0660270 katherine ornstein funded grant r01ag060967 author contributions study concept design rivera aldridge ornstein chun analysis interpretation data aldridge moody chun preparation manuscript authors sponsors role funders played role studys design methods data collection analysis preparation article references 1batsis ja dimilia pr seo lm et al effectiveness ambulatory telemedicine care older adults systematic review j geriatr soc 2019 67 1737 1749 wiley online librarypubmedweb sciencegoogle scholar 2dang olsan karuza j et al telehealth homebased primary care factors challenges associated integration veteran care j geriatr soc 2019 67 1928 1933 wiley online librarypubmedweb sciencegoogle scholar 3cella g ata commends congress giving hhs authority waive restrictions telehealth medicare beneficiaries response covid19 outbreak arlington va american telehealth association 2020 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