OHSU 2019-2020 utilization of ambulatory telehealth and office visits by patient demographics

The COVID-19 pandemic and subsequent expansion of telehealth may be
exacerbating inequities in ambulatory care access due to institutional and
structural barriers. We conduct a repeat cross-sectional analysis of
ambulatory patients to evaluate for demographic disparities in the
utilization of telehealth modalities. The ambulatory patient
population at Oregon Health & Science University (Portland, OR) is
examined from June 1 through September 30, in 2019 (reference period) and
in 2020 (study period). We first assess for changes in demographic
representation and then evaluate for disparities in the utilization of
telephone and video care modalities using logistic regression. Between the
2019 and 2020 periods, patient video utilization increased from 0.2% to
31%, and telephone use increased from 2.5% to 25%. There was also a small
but significant decline in the representation males, Asians, Medicaid,
Medicare, and non-English speaking patients. Amongst telehealth users,
adjusted odds of video participation were significantly lower for those
who were Black, American Indian, male, prefer a non-English language, have
Medicaid or Medicare, or older. A large portion of ambulatory patients
shifted to telehealth modalities during the pandemic. Seniors, non-English
speakers, and Black patients were more reliant on telephone than video for
care. The differences in telehealth adoption by vulnerable populations
demonstrate the tendency towards disparities that can occur in the
expansion of telehealth and suggest structural biases. Organizations
should actively monitor the utilization of telehealth modalities and
develop best-practice guidelines in order to mitigate the exacerbation of
inequities.