Telemedicine in the Wake of the COVID-19 Global Pandemic:Increasing Access to Surgical Care for Disadvantaged Patients
Paige Dekker, BA1, Priya Bhardwaj, MS1, Tanvee Singh, MPH1, Jenna Bekeny, BA2, Karen K. Evans, MD2, David H. Song, MD MBA2, Christopher E. Attinger, MD2, Kenneth L. Fan, MD2.
1Georgetown University School of Medicine, Washington, DC, USA, 2Department of Plastic and Reconstructive Surgery, MedStar Georgetown University Hospital, Washington, DC, USA.
Background: The COVID-19 pandemic has induced drastic changes in the way healthcare is delivered, including the broadened adaptation of telemedicine platforms. Existing research on rural populations suggests that telemedicine enhances access to care, but little is known about whether these benefits are also experienced by disadvantaged populations. The objective of this study is to explore the impact of telemedicine in the disadvantaged population in an urban setting. Methods: Outpatient appointments amongst five providers in the Plastic and Reconstructive Surgery Department between March 2, 2020 and April 10, 2020 were retrospectively reviewed. Appointment and patient characteristics were collected from the electronic health record. Census Bureau Zip Code Tabulation Areas (ZCTA) were used to help extrapolate patient residence locality designation (city/suburb/town/rural) from the National Center for Education Statistics (NCES) 2019 data as well as median income by area of residence from the S1901 table from the 2019 American Community Survey. Residential addresses of patients were assigned to census tracts according to the Census Bureau geocoding system, and these census tracts were then used to assign a single overall Social Vulnerability Index (SVI) from the CDC to each patient. The SVI is a metric used to assess disaster and pandemic resilience. The primary outcome of interest was whether or not a patient showed for their scheduled appointment (show versus no-show). Two separate multivariate models were constructed for before and after the COVID-19 lockdown.Results: There was a total of 784 patient appointments during the study period. Bivariate analysis showed that prior to the COVID-19 pandemic, younger (p=0.006), established (0.035), male (p=0.032) patients with Medicaid (p=0.027) were more likely to miss their appointments. Multivariate analysis revealed that patients with a higher SVI were also more likely to miss their appointment (0.49 vs 0.39, p=0.007) prior to the lockdown. Multivariate regression modeling showed that for every 0.1 increase in SVI, there was a 1.32 greater odds of loss to follow up. After the lockdown, neither socioeconomic status (as measured by SVI), nor age, nor established status, nor sex, nor insurance were any longer significantly related to no-show appointments.Conclusions: This study demonstrates enhanced access to care and therefore a reduction in healthcare disparity following the increased use of telemedicine during the COVID-19 pandemic. The findings of this study support the overall benefits that are cited in the current literature regarding telemedicine and expand these findings to include disadvantaged populations.
Back to 2020 Abstracts