Vulnerable populations sought virtual care during pandemic
Kaiser Permanente Southern California patients who were Latinx or low-income had the largest percentage increase in use of telehealth during the COVID-19 pandemic, according to Kaiser Permanente research recently published in Journal of Medical Internet Research.
Increases in telehealth visits during the COVID-19 pandemic varied across age, sex, race/ethnicity, and household income groups, while decreases in outpatient visits were similar across all subgroups except age groups. The rate of combined outpatient and telehealth visits in the Latinx, Black, and low-income groups returned to pre-pandemic levels by October 2020.
“The use of virtual care during the pandemic shows us it is a potentially promising way to reduce health care disparities even after the pandemic ends,” said Lei Qian, PhD, a research scientist with the Kaiser Permanente Southern California Department of Research & Evaluation. “The study also showed that while seniors had the highest telehealth visit rates before and during the pandemic, they had the smallest percentage increase in telehealth visits during the pandemic among all age groups, suggesting that barriers may exist for many seniors.”
The retrospective cohort study was conducted at Kaiser Permanente Southern California, which has more than 4.7 million racially, ethnically, and socioeconomically diverse members at its 15 hospitals and 234 medical offices. Researchers studied the period of January 5, 2020 to October 31, 2020 (Week 1 to Week 43 in 2020) and the corresponding period in 2019 to determine the change in outpatient visits and telehealth visits. Weekly rates of outpatient and telehealth visits by age, sex, race/ethnicity, and neighborhood-level median household income were calculated and compared before and during the COVID-19 pandemic.
- Across all subgroups, outpatient visit rates had a steep drop-off after the start of the pandemic, reaching their lowest levels by early April 2020 (Week 14), then gradually increasing, but remaining lower than pre-pandemic levels.
- Across age groups, the outpatient visits decreased the least among patients 65 years and older (−29.6%) and the most among children ages 6 to 17 years (−50.2%).
- Across all subgroups, telehealth visits increased sharply after the start of the pandemic.
- Across age groups, the telehealth visits increased the most among children ages 0 to 5 years and the least among adults ages 65 years and older.
- Telehealth visits increased more among males (293.9%) than females (260%) during the early pandemic.
- Across racial/ethnic groups, Latinx patients had the largest increase in telehealth visits across income levels with a 295.5% increase in telehealth visits, although their visit rates during the pre-pandemic and pandemic periods were lower than those of Black and white patients.
- Across income levels, patients who were in the low-income group had the largest increase (313.5%) in telehealth visits.
- The rate of combined outpatient and telehealth visits in the Latinx, Black, and low-income groups returned to pre-pandemic levels by October 2020.
Dr. Qian said she sees the popularity of telehealth continuing beyond the pandemic.
“Given the growing familiarity with new telehealth technologies, even as the COVID-19 pandemic wanes, patients likely will continue to pursue telehealth services beyond pre-pandemic levels,” she said.
This study was funded by Kaiser Permanente Southern California.
Other authors on this study from the Kaiser Permanente Southern California Department of Research & Evaluation are Lina S. Sy, MPH; Vennis Hong, MPH; Sungching Glenn, MS; Denison S. Ryan, MPH; Kerresa Morrissette, MPH; and Stanley Xu, PhD. Steven J. Jacobsen, MD, PhD, formerly of the Department of Research & Evaluation, also is a co-author.