Medical practices have increased electronic messaging and telemedicine visits during the last several years. This rise in electronic health care during the COVID pandemic minimized SARS-CoV-2 exposure and disease transmission. Historically, African-Americans and older patients have less frequently used electronic messaging with their physicians. This study compares the utilization of virtual health care before and during the COVID pandemic by inflammatory bowel disease (IBD) patients.
A retrospective medical record review of all IBD patients seen at an academic medical center from 2014 to 2020 was conducted to evaluate the use of telehealth options (e-messaging, e-visits) during a pre-COVID and a COVID timeframe. Patient age, gender, race, IBD subtype (Crohn's disease, ulcerative colitis or indeterminate colitis), electronic messaging, and telehealth visits were obtained. A pre-COVID IBD cohort was identified from the 2015–2018 records. The pre-COVID timeframe evaluated was March-August 2018. A COVID IBD cohort was identified from the 2017–2020 records. The COVID timeframe evaluated was March-August 2020. A confidential database was created using Microsoft Excel. Statistical analysis was performed using Fisher Exact test with significance set at P < 0.05. The study was IRB approved.
There were 392 patients (174 males, 218 females; mean age 44.4 years) in the pre-COVID cohort. 97 had Crohn's disease, 278 had ulcerative colitis and 17 had indeterminate colitis. There were 204 White, 99 African American, 11 Asian, and 78 ethnically un-identified patients. One hundred sixty (40.8%) initiated E-communication with their physicians, however E-visits were not an option. E-messaging was initiated significantly more by White patients compared to African American patients (62.3% vs 28.2%; P < 0.00001). Patients <50 years of age used e-messaging significantly more than those > 50 (51.1% vs 39.7%; P = 0.0396). There were no significant differences in the use of e-messaging based upon patient gender (P = 0.6840) or IBD type (P = 0.6374). There were 295 patients (130 males, 165 females; mean age 45.7 years) in the COVID cohort. 76 had Crohn's disease and 208 had ulcerative colitis. There were 155 White, 83 African American patients, 24 Hispanic patients, 10 Asian patients, and 22 ethnically un-identified patients. 109 (36.9%) utilized a telehealth option (53 via e-messaging; 56 via telemedicine visit). There was no significant difference in the use of a telehealth option based upon race (42.6% White vs 35.9% African-American; P = 0.2693), age (36.8% < 50 vs 37.25% > 50 years; P = 1.00) or IBD type (P = 0.331). Males used telehealth more than females (46.1% vs 29.7%, respectively; P = 0.0051).
The COVID pandemic encouraged physicians to incorporate telehealth options into their practice. Prior to the COVID pandemic, patients were able to e-message their physicians. However, the pandemic emergency enabled medical practices to offer e-visits in addition to e-messaging for care delivery. This study revealed that expanded telemedicine options for IBD patients eliminated previously identified racial and age disparities in virtual medical care. Further study is needed to understand gender differences in telehealth utilization. There should be post-pandemic policy consideration for continued telemedicine options to encourage expanded patient-physician engagement, support continuity in care and optimize IBD outcomes.