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Telemedicine Outpatient Cardiovascular Care during the COVID-19 Pandemic: Bridging or Opening the Digital Divide?

Eberly LA, Khatana SAM, Nathan AS, et. al. Circulation: 10.1161/CIRCULATIONAHA.120.048185

Background:

  • The use of digital/telephone systems for patient management has increased significantly during the COVID crisis.
  • The likelihood is that utilization of telephone and telemedicine (video) remote medical evaluation will continue going forward.
  • A above referenced manuscript addresses the population variations and acceptance and effective utilization of telephone and telemedicine based on social and personal characteristics.
  • This emphasizes that to be effective, specific factors needed to be considered in achieving optimal communication methods despite the increased flexibility of telemedicine.

Key Points:

  • While, telemedicine removes many barriers regarding travel, cost of transportation and parking for frail or otherwise patients with restrictive access, patients may have similar or different challenges to telemedicine (with video) as well.
  • Patients with potential challenges to particularly video based medical visits include, older patients (limits to understanding or using technology) poorer patients (poor access to required equipment and broadband) and non-English speaking patients with general communication limits exacerbated by technology.
  • This is a single, large center (University of Pennsylvania) evaluation of patients scheduled for a telemedicine visit, comparing factors involved in successfully completed visits vs. non-completed visits including a comparison of telephone vs. video encounters.
  • Analyzed visits were assessed between March 16 – April 17, 2020 during the height of restricted visits.
  • There were 2940 scheduled visits during this time of which 1,339 (46%) were completed and 1,601 (54%) were canceled/no-show visits.
  • Numerically small but significant differences for those completing a telemedicine visit included patient age (mean 63 vs. 63, p<0.0001), being male (51% vs, 44%, p<0.0001) and English speaking (99% vs. 98%, p=0.03).
  • There were no differences based on race/ethnicity, insurance/payor status or zip-come linked household income.
  • were no differences based on race/ethnicity (p=0.25), insurance/payor class (p=0.12), or zip-code linked household income (p=0.38).
  • Comparing telemedicine (video) vs. telephone-only visit completion, patients completing video visits were greater for males) 50% vs. 42%, p=0.01) but less likely to be black (24% vs. 34%, p<0.01) but likely to have a higher income.
  • In terms of independent associations, non-English language was associated with a >50% lower telemedicine use, along with a lower use for females and a lower use for yearly incomes less than $50,000.
  • While explanations for some of these observations such as lower use by females will require more in-depth study and the potential for expanded broadband and other digital enhancements including increased use of translation services are likely to occur, for the present, being aware of specific patient circumstances effecting patient acceptance and use of telephone and video medical services is critical for success.