Who Is (and Isn't) Receiving Telemedicine Care During the COVID-19 Pandemic

Cantor, Jonathan; McBain, Ryan K.; Pera, Megan F.; Bravata, Dena M.; Whaley, Christopher

Introduction The coronavirus disease 2019 (COVID-19) pandemic has forced telehealth to be the primary mechanism for patients to interact with their providers. There is a concern that the pandemic will exacerbate existing disparities in overall healthcare utilization and telehealth utilization. Few national studies have examined changes in telehealth use during the COVID-19 pandemic. Methods Data on 6.8 and 6.4 million employer-based health plan beneficiaries in 2020 and 2019 were collected in 2020. Unadjusted rates were compared both before and after the week of the declaration of COVID-19 pandemic as a national emergency. Trends in weekly utilization were also examined using a difference-in-differences regression framework to quantify changes in telemedicine and office-based care utilization while controlling for the patient's demographic and county-level sociodemographic measures. All analyses were conducted in 2020. Results More than a 20-fold increase in the incidence of telemedicine utilization following March 13, 2020 was observed. Conversely, the incidence of office-based encounters declined almost 50% and was not fully offset by the increase in telemedicine. The increase in telemedicine was greatest among patients in counties with low poverty levels (β=31.70, 95% CI=15.17, 48.23), among patients in metropolitan areas (β=40.60, 95% CI=30.86, 50.34), and among adults compared with children aged 0–12 years (β=57.91, 95% CI=50.32, 65.49). Conclusions The COVID-19 pandemic has affected telehealth utilization disproportionately based on patient age, and both county-level poverty rate and urbanicity.