Telemedicine Disparities in Ambulatory Cardiology Visits in a Large Academic Health System

Abstract

Background: The COVID-19 pandemic prompted rapid expansion of telemedicine to access subspecialty care. However, potential disparities in access to telemedicine in cardiology remain to be fully characterized. Objectives: The authors aimed to study whether telemedicine visit modality (video or audio only) differed by sociodemographic characteristics in the outpatient cardiology population of a large academic health center. Methods: We conducted a retrospective cross-sectional study of telemedicine encounter data from all outpatient cardiology telemedicine visits from January 1, 2020, to December 31, 2021. We examined unique patients’ first telemedicine encounter during the study period. The primary outcome was visit modality, video versus audio-only visit. Predictors of audio-only visit modality were assessed using adjusted logistic regression analyses. Results: There were 47,961 total adult cardiology telemedicine encounters among 39,381 unique patients. Of all encounters, 20.4% were audio only. Odds of audio-only visit modality increased with age, with the highest odds of audio-only visits in patients aged >75 years (OR: 3.4; 95% CI: 2.8-4.2). Non-White race (OR: 1.2; 95% CI: 1.1-1.3), lack of private insurance (Medicaid OR: 2.8; 95% CI: 2.5-3.1 and Medicare OR: 1.7; 95% CI: 1.5-1.8), and higher social deprivation index quintile (social deprivation index 5, most deprived, OR: 2.0; 95% CI: 1.9-2.2) were also associated with increased odds of audio-only modality. Conclusions: We identified sociodemographic disparities in telemedicine visit modality in a large outpatient cardiology population. These findings highlight the important role of audio-only visits in accessing telemedicine, and opportunities to narrow the digital health divide.

Keywords

• ambulatory care
• digital health
• disparities
• health services research