Original Scientific Articles

Demographic Disparity in Use of Telemedicine for Ambulatory General Surgical Consultation During the COVID-19 Pandemic: Analysis of the Initial Public Health Emergency and Second Phase Periods

Eruchalu, Chukwuma N BS; Bergmark, Regan W MD, FACS; Smink, Douglas S MD, MPH, FACS; Tavakkoli, Ali MD, FACS; Nguyen, Louis L MD, MBA, MPH, FACS; Bates, David W MD, MSC; Cooper, Zara MD, MSC, FACS; Ortega, Gezzer MD, MPH

Author Information

From the Harvard Medical School, Boston, MA (Eruchalu)

Center for Surgery and Public Health, Department of Surgery (Eruchalu, Bergmark, Smink, Nguyen, Cooper, Ortega), Brigham and Women’s Hospital, Harvard Medical School, Boston, MA

Division of General and Gastrointestinal Surgery, Department of Surgery (Smink, Tavakkoli), Brigham and Women’s Hospital, Harvard Medical School, Boston, MA

Laboratory for Surgical and Metabolic Research (Tavakkoli), Brigham and Women’s Hospital, Harvard Medical School, Boston, MA

Division of Vascular and Endovascular Surgery, Department of Surgery (Nguyen), Brigham and Women’s Hospital, Harvard Medical School, Boston, MA

Division of General Internal Medicine, Department of Medicine (Bates), Brigham and Women’s Hospital, Harvard Medical School, Boston, MA

Division of Trauma, Burn, and Surgical Critical Care, Department of Surgery (Cooper), Brigham and Women’s Hospital, Harvard Medical School, Boston, MA

the Department of Health Policy and Management, Harvard T.H. Chan School of Public Health, Boston, MA (Bates).

Correspondence address: Gezzer Ortega, MD, MPH, Center for Surgery and Public Health, Brigham and Women’s Hospital, Harvard Medical School, One Brigham Circle, 1620 Tremont St, Suite 2-016, Boston, MA 02120. email: [email protected]

Disclosure Information: Nothing to disclose.

Disclosures outside the scope of this work: Dr Bates is a paid consultant to CDI Negev and AESOP Technology; receives grant funding from EarlySense and IBM Watson Health Technology; and holds stock in ValeraHealth, Clew, MDClone, LTD, and AESOP Technology. The other authors have nothing to disclose.

Presented virtually at the American College of Surgeons 107th Annual Clinical Congress, October 2021.

Supplemental digital content for this article is available at https://links.lww.com/XCS/A19.

Received August 11, 2021; Revised September 30, 2021; Accepted October 5, 2021.

Journal of the American College of Surgeons 234(2):p 191-202, February 2022. | DOI: 10.1097/XCS.0000000000000030

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BACKGROUND:

Surgical patients with limited digital literacy may experience reduced telemedicine access. We investigated racial/ethnic and socioeconomic disparities in telemedicine compared with in-person surgical consultation during the coronavirus disease 2019 (COVID-19) pandemic.

STUDY DESIGN:

Retrospective analysis of new visits within the Division of General & Gastrointestinal Surgery at an academic medical center occurring between March 24 through June 23, 2020 (Phase I, Massachusetts Public Health Emergency) and June 24 through December 31, 2020 (Phase II, relaxation of restrictions on healthcare operations) was performed. Visit modality (telemedicine/phone vs in-person) and demographic data were extracted. Bivariate analysis and multivariable logistic regression were performed to evaluate associations between patient characteristics and visit modality.

RESULTS:

During Phase I, 347 in-person and 638 virtual visits were completed. Multivariable modeling demonstrated no significant differences in virtual compared with in-person visit use across racial/ethnic or insurance groups. Among patients using virtual visits, Latinx patients were less likely to have video compared with audio-only visits than White patients (OR, 0.46; 95% CI 0.22–0.96). Black race and insurance type were not significant predictors of video use. During Phase II, 2,922 in-person and 1,001 virtual visits were completed. Multivariable modeling demonstrated that Black patients (OR, 1.52; 95% CI 1.12–2.06) were more likely to have virtual visits than White patients. No significant differences were observed across insurance types. Among patients using virtual visits, race/ethnicity and insurance type were not significant predictors of video use.

CONCLUSION:

Black patients used telemedicine platforms more often than White patients during the second phase of the COVID-19 pandemic. Virtual consultation may help increase access to surgical care among traditionally under-resourced populations.