Growth of telehealth under COVID-19 mostly only in rich, urban areas

The use of telehealth increased sharply during the novel coronavirus disease pandemic (COVID-19), according to a new study. However, most of the uptake has been in urban centres, benefitting high-income metropolitan dwellers.

“This study is an important first step in collective understanding of telehealth utilization as the COVID-19 pandemic progresses. There is uncertainty in whether current rates and disparities in telehealth will continue,” the researchers said.

“Given the results, policymakers should make a more concerted effort to reach populations that are deferring in-office care and not replacing it with telehealth visits,” they added.

The study population included over 6 million health plan beneficiaries across the United States. Healthcare utilization was expressed as the number of people receiving procedures per week per 10,000 eligible individuals, and incidence rates were calculated separately for in-office and telemedicine visits.

Video and phone consults were classified under telemedicine, while in- and outpatient consultations, facility visits, and preventive care were all defined as office-based healthcare utilization. Changes in utilization were compared before and after 13 March 2020, when the pandemic was declared a national emergency.

After COVID-19, rates of total healthcare visits dropped across all age groups, socioeconomic strata, and geographical location of residence. [Am J Prev Med 2021;doi:10.1016/j.amepre.2021.01.030]

Such a decrease was driven mainly by a sharp decline in in-person care. Among young children (aged 0–12 years), for example, weekly in-office visits dropped from 751.7 to 426.9 person per 10,000 eligible beneficiaries after the pandemic. Similar changes were observed across all patient subgroups.

In contrast, the researchers observed large increases in telemedicine utilization after 13 March, particularly among elderly adults (aged ≥46 years). Where only 2.8 people per 10,000 beneficiaries used telehealth on a weekly basis before the pandemic, 121.4 had such an engagement post-COVID-19. Jumps in telemedicine engagement were observed across all age groups, though such changes were nevertheless unable to offset the drop in in-person visits.

However, when researchers stratified analysis according to socioeconomic status and geographic location, they saw signals of worsening health disparity associated with telemedicine uptake.

Grouping US counties into quartiles according to the percentage of their population below the poverty line showed that in those with the lowest rates of poverty, weekly telemedicine use jumped by more than 100 persons per 10,000 eligible beneficiaries, as opposed to only 80.7 in counties with the highest poverty. Metropolitan areas also saw greater increase in telemedicine engagement than rural counties.

Regression analysis showed that engagement in telemedicine was greatest among counties with low poverty levels (β, 31.70, 95 percent confidence interval [CI], 15.17–48.23) and in metropolitan areas (β, 40.60, 95 percent CI, 30.86–50.34).

“This study provides evidence on the increased use of telehealth during the COVID-19 pandemic by using national claims data for >6 million individuals. There are substantial disparities in the use of telehealth by patient age and county-level measures for poverty rate and urbanicity,” the researchers said.