Table_2_Racial and ethnic disparities in telehealth use before and after California's stay-at-home order.XLSX

IntroductionTelehealth can potentially improve the quality of healthcare through increased access to primary care. While telehealth use increased during the COVID-19 pandemic, racial/ethnic disparities in the use of telemedicine persisted during this period. Little is known about the relationship between health coverage and patient race/ethnicity after the onset of the COVID-19 pandemic.ObjectiveThis study examines how differences in patient race/ethnicity and health coverage are associated with the number of in-person vs. telehealth visits among patients with chronic conditions before and after California's stay-at-home order (SAHO) was issued on 19 March 2020.MethodsWe used weekly patient visit data (in-person (N = 63, 491) and telehealth visits (N = 55, 472)) from seven primary care sites of an integrated, multi-specialty medical group in Los Angeles County that served a diverse patient population between January 2020 and December 2020 to examine differences in telehealth visits reported for Latino and non-Latino Asian, Black, and white patients with chronic conditions (type 2 diabetes, pre-diabetes, and hypertension). After adjusting for age and sex, we estimate differences by race/ethnicity and the type of insurance using an interrupted time series with a multivariate logistic regression model to study telehealth use by race/ethnicity and type of health coverage before and after the SAHO. A limitation of our research is the analysis of aggregated patient data, which limited the number of individual-level confounders in the regression analyses.ResultsOur descriptive analysis shows that telehealth visits increased immediately after the SAHO for all race/ethnicity groups. Our adjusted analysis shows that the likelihood of having a telehealth visit was lower among uninsured patients and those with Medicaid or Medicare coverage compared to patients with private insurance. Latino and Asian patients had a lower probability of telehealth use compared with white patients.DiscussionTo address access to chronic care management through telehealth, we suggest targeting efforts on uninsured adults and those with Medicare or Medicaid coverage, who may benefit from increased telehealth use to manage their chronic care.

引言：远程医疗有望通过提高初级保健的获取途径来提升医疗保健的质量。尽管在COVID-19大流行期间远程医疗的使用有所增加，但种族/民族在使用远程医疗方面的不平等现象在此期间依然存在。关于COVID-19大流行爆发后医疗覆盖范围与患者种族/民族之间的关系，所知甚少。研究目标：本研究旨在探讨在加利福尼亚州于2020年3月19日发布居家令（SAHO）之前和之后，慢性病患者（包括2型糖尿病、糖尿病前期和高血压患者）的种族/民族差异和医疗覆盖范围的差异如何与面对面访问和远程医疗访问的数量相关。方法：我们使用了来自洛杉矶县一家综合多学科医疗集团七个初级保健站点在2020年1月至12月期间的每周患者访问数据（面对面访问（N = 63,491）和远程医疗访问（N = 55,472）），以研究对于拉丁美洲裔和非拉丁美洲裔亚洲、非洲裔和白色慢性病患者报告的远程医疗访问差异。在调整年龄和性别后，我们使用带有多元逻辑回归模型的断点时间序列来估计种族/民族和保险类型之间的差异，以研究SAHO前后远程医疗的使用情况。我们研究的局限性在于对聚合患者数据的分析，这限制了回归分析中个体水平混杂因素的数量。结果：我们的描述性分析显示，在SAHO发布后，所有种族/民族群体的远程医疗访问立即增加。我们的调整分析显示，与拥有私人保险的患者相比，无保险患者以及拥有医疗补助或医疗保险的患者进行远程医疗访问的可能性较低。与白人患者相比，拉丁美洲裔和亚洲患者的远程医疗使用概率较低。讨论：为了解决通过远程医疗获取慢性病管理服务的问题，我们建议针对无保险成年人以及那些可能有医疗保险或医疗补助保险的人进行努力，他们可能从增加的远程医疗使用中受益，以便管理他们的慢性病。