Telehealth Increased Healthcare Access for Hispanic, Low-Income Populations During COVID-19

Virtual care can reduce healthcare disparities even after the pandemic ends.

Hispanic and low-income communities have the largest percentage increase in telehealth use in response to the COVID-19 pandemic.

Findings of the study suggested virtual care can potentially mitigate the impact of the pandemic on healthcare use in vulnerable populations.

Due to the COVID-19 pandemic, there were dramatic decreases in outpatient healthcare visits and increases in telehealth visits. Still, healthcare workers and investigators were unsure of whether the changes in healthcare access were different based on patient demographics and socioeconomic status.

Lei Qian, Ph.D., and a team of investigators from Kaiser Permanente Southern California assessed the impact of the pandemic on in-person outpatient and telehealth visits by demographic characteristics and household income in a diverse population. The study cohort comprised patients of all ages who were members from January 5, 2020, to October 31, 2020 and the same period in 2019.

The investigators identified outpatient and telehealth visits using the electronic health record (EHR) data and claims data. Outpatient visits included all in-person outpatient visits and telehealth visits included telephone appointment visits and video visits conducted synchronously using real-time telephone or live video-audio interactions.

Of the more than 4.5 million members enrolled in January 2020, 15% were at least 65 years old, 51.5% were female, 39.4% were Hispanic, and 7.7% lived in census tract areas with a median household income less than $40,000.

After the start of the pandemic, outpatient visit rates had a steep drop-off across all sub-groups. Lowest levels of outpatient visits were in early April 2020, then gradually increased but still remained lower than before the pandemic. Patients at least 65 years old had the smallest decrease in outpatient visits with 6.25 visits per person-year during the later pandemic period versus 8.92 visits per person-year during the pre-pandemic period in 2020. Those aged 6-17 years old had the largest decrease, with 1.92 visits per person-year during the later pre-pandemic period versus 3.86 visits per person-year during the pre-pandemic period in 2020. Outpatient visit decreases did not differ statistically by sex, race/ethnicity, and household income groups.

In all sub-groups except patients aged 6-17 years old, telehealth visits increased after the start of the COVID-19 pandemic and then slowly decreased. For those aged 6-17 years old, telehealth visit rates remained stable after initial increase during the pandemic.

Telehealth visits increased the most for children aged 0-5 years old (475.5%; 95% CI, 446.2-506.4) and the least among adults at least 65 years old (236.6%; 95% CI, 228.8-244.5). Such visits increased significantly more among males (293.9%; 95% CI, 283.4-304.7) than females (260%; 95% CI, 252.6-267.6). What’s more, Hispanic patients had the largest increase in telehealth visits (295.5%; 95% CI, 275.5-316.5), and visits for patients in the low-income group increased the most (313.5%; 95% CI, 294.8-333.1).

The use of telehealth and virtual care among these sub-groups reduced exposure to COVID-19, reinforced social distancing, increased the number of patients who could be treated, and may have mitigated the impact of COVID-19 in vulnerable populations.

“Furthermore, the use of virtual care might be a promising way to reduce healthcare disparities even after the COVID-19 pandemic ends,” Qian and the team concluded.

The study, “Disparities in Outpatient and Telehealth Visits During the COVID-19 Pandemic in a Large Integrated Health Care Organization: Retrospective Cohort Study,” was published online in the Journal of Medical Internet Research.