By Nicole Lou

Characteristics of patients who made it to their scheduled telemedicine appointments during the early days of the COVID-19 pandemic suggested inequities in access to care, researchers found.

Of the nearly 150,000 people who had telemedicine appointments with one large health system from March 16 to May 11, 2020, 54.4% completed their virtual visits, according to Srinath Adusumalli, MD, MSc, of Hospital of the University of Pennsylvania in Philadelphia, and colleagues.

The shift to telemedicine during the pandemic was not universally seamless, as scheduled visits at primary care and medical specialty clinics were significantly less likely to be completed among patients with:

-Older age (adjusted OR 0.67 for those 75 and older vs under 55)

-Asian vs White race (adjusted OR 0.69)

-A preferred language other than English (adjusted OR 0.84)

-Medicaid (adjusted OR 0.93 vs commercial insurance)

"The COVID-19 pandemic has devastated communities of color and marginalized populations, exposing the deep inequities of our U.S. health care system. The findings of this study demonstrate that significant inequities are also present among patients in accessing necessary telemedicine care," Adusumalli's group wrote.

"Although many have anxiously awaited a return to 'normal,' we must acknowledge that our previous 'normal' was a U.S. health care system and digital connectivity landscape fraught with inequity. As we build our telemedical health system, which is likely here to stay, a new 'normal' must prioritize the needs of those who have been historically marginalized to ensure that health equity is achieved," the authors urged.

Adusumalli and colleagues cited evidence of a digital divide resulting in lower rates of technology and broadband adoption among older patients, racial minority groups, and those of lower socioeconomic status.

Older people in particular may have better telemedicine access with care platforms designed to address audio, visual, and motor impairment. They may also benefit from getting broadband coverage and having someone alleviate their concerns about privacy, the investigators suggested.

In addition, they said their institution is trying to address the racial and language gaps by formalizing efforts to contact patients in their native language and offering translation technology in its platforms.

Attention should be paid to socioeconomic factors in healthcare delivery, agreed Sarah Koch, PhD, of Spain's Barcelona Institute of Global Health, and colleagues writing in an accompanying commentary.

"In any health-related research, but particularly in COVID-19 research, exposures and outcomes, including access to care, should be interpreted also as end products of institutions and policies. Thus, we call for more dialogue between natural and social sciences, based on the recognition that pandemics manifest on all levels of health," Koch's group wrote.

"Such a multilayered approach is a must as we reimagine health research methods in a world where zip codes matter more than genetic codes," according to the trio.

The retrospective cohort study was based on the electronic health records of a large academic health system covering parts of Pennsylvania and New Jersey.

There were 148,402 patients (58.0% women, mean age 56.5 years) with telemedicine visits scheduled with primary care and medical specialty ambulatory care at the University of Pennsylvania health system during the study period.

Adusumalli's team reported that phone calls accounted for approximately 57% of completed telemedicine visits. Video calls were less likely in people with older age, female sex, Black race, Latinx ethnicity, and lower household income.

The Centers for Medicare and Medicaid Services had ruled to temporarily expand reimbursement for phone and video visits due to the pandemic.

"It is critical that complete payment parity for all types of telemedicine visits, by all insurance payers, is guaranteed through permanent legislative action. Lower reimbursement for telephone visits may disproportionately and unjustly hurt clinics and clinicians that care for patients in minority groups and patients with lower income," study authors said.

Investigators couldn't be sure why some patients didn't show up to their appointments, they acknowledged. Moreover, trends may have changed since the initial period of transition to telemedicine.