| الوصف: |
Background: Telemedicine has become one of the standards in healthcare delivery, particularly since onset of the COVID pandemic. However, healthcare disparities in telemedicine care delivery among historically disadvantaged groups remains unclear with most studies demonstrating its persistence. We aim to evaluate patient and healthcare system factors in telemedicine utilization in a large, diverse population. Methods: Retrospective study of patient visits across Kaiser Permanente Southern California between January 1, 2019, and June 30, 2021. Patient factors included age, gender, ethnicity, median household income, primary spoken/written language, marital status, and registration on kp.org. Healthcare factors included type of visit, provider age, gender, specialty, number of years in practice and primary language. Rates of utilization compared between office and virtual visits, prior to and after March 2020, with an interrupted time series and slope analysis. Results: There were 177,171,288 visits during the study period. There was a decrease in patient visits after March 2020 (lockdown), driven by a sharp decline in office visits. Within three months of lockdown, total visits increased until the end of study, at 2.8 million/month, compared to 2.5 million/month prior to lockdown, driven by office visits that approached pre-lockdown and high telemedicine visits. In a multivariate regression analysis, there were no significant differences in patient age, race, gender, income, marital status, language, and kp.org registration in telemedicine utilization. Providers with 6-10 years in practice, aged < 30 utilized the most telemedicine (p=.01). General surgery, medical specialties, OBGYN, pediatrics and psychiatry utilized more telemedicine compared to primary care, but podiatry and surgical specialties utilized less (p < 0.01). Conclusions: Our study of over 177 million patient visits in an integrated healthcare system of a large, diverse population shows sustained high utilization of telemedicine after the pandemic lockdown, with an increase of office visits, and overall increase of total patient visits. No significant healthcare disparities across various populations were found in telemedicine utilization, contrary to most current literature demonstrates. Results of this study may prompt more investigation to the role of telemedicine in various populations. |
