Abstract
Abstract
Background
Research exploring telehealth expansion during the COVID-19 pandemic has demonstrated that groups disproportionately impacted by COVID-19 also experience worse access to telehealth. However, this research has been cross-sectional or short in duration; geographically limited; has not accounted for pre-existing access disparities; and has not examined COVID-19 patients. We examined virtual primary care use by race/ethnicity and community social vulnerability among adults diagnosed with COVID-19 in a large, multi-state health system. We also assessed use of in-person primary care to understand whether disparities in virtual access may have been offset by improved in-person access.
Methods
Using a cohort design, electronic health records, and Centers for Disease Control and Prevention Social Vulnerability Index, we compared changes in virtual and in-person primary care use by race/ethnicity and community social vulnerability in the year before and after COVID-19 diagnosis. Our study population included 11,326 adult patients diagnosed with COVID-19 between March and July 2020. We estimated logistic regression models to examine likelihood of primary care use. In all regression models we computed robust standard errors; in adjusted models we controlled for demographic and health characteristics of patients.
Results
In a patient population of primarily Hispanic/Latino and non-Hispanic White individuals, and in which over half lived in socially vulnerable areas, likelihood of virtual primary care use increased from the year before to the year after COVID-19 diagnosis (3.6 to 10.3%); while in-person use remained stable (21.0 to 20.7%). In unadjusted and adjusted regression models, compared with White patients, Hispanic/Latino and other race/ethnicity patients were significantly less likely to use virtual care before and after COVID-19 diagnosis; Hispanic/Latino, Native Hawaiian/Pacific Islander, and other race/ethnicity patients, and patients living in socially vulnerable areas were also significantly less likely to use in-person care during these time periods.
Conclusions
Newly expanded virtual primary care has not equitably benefited individuals from racialized groups diagnosed with COVID-19, and virtual access disparities have not been offset by improved in-person access. Health systems should employ evidence-based strategies to equitably provide care, including representative provider networks; targeted, empowering outreach; co-developed culturally and linguistically appropriate tools and technologies; and provision of enabling resources and services.
Funder
William E. and Thelma F. Housman Foundation
Publisher
Springer Science and Business Media LLC
Reference76 articles.
1. Covid in the U.S. Latest Map and Case Count. New York Times. 2022. Available from: https://www.nytimes.com/interactive/2021/us/covid-cases.html [cited 28 Jan 2022]
2. Du Bois W. The Philadelphia negro; a social study. Philadelphia: Published for the University; 1899. Available from: https://search.library.wisc.edu/catalog/999852732802121
3. Hargrove TW. Structural Racism and Inequalities in Health: Footnotes: a publication of the American Sociological Association; 2021. Available from: https://www.asanet.org/news-events/footnotes/apr-may-jun-2021/features/structural-racism-and-inequalities-health [cited 3 Jan 2022]
4. Beltrán-Sánchez H, Soneji S, Crimmins EM. Past, present, and future of healthy life expectancy. Cold Spring Harb Perspect Med. 2015;5(11) Available from: https://pubmed.ncbi.nlm.nih.gov/26525456/ [cited 3 Jan 2022].
5. Bailey ZD, Feldman JM, Bassett MT. How structural racism works — racist policies as a root cause of U.S. racial health inequities. N Engl J Med. 2021;384(8):768–73 Available from: https://www.nejm.org/doi/full/10.1056/NEJMms2025396 [cited 3 Jan 2022].
Cited by
15 articles.
订阅此论文施引文献
订阅此论文施引文献,注册后可以免费订阅5篇论文的施引文献,订阅后可以查看论文全部施引文献