Age and socioeconomic status affect access to telemedicine at an urban level 1 trauma center.

Objectives: Despite clinical and economic advantages, routine utilization of telemedicine remains uncommon. The purpose of this study was to examine potential disparities in access and utilization of telehealth services during the rapid transition to virtual clinic during the coronavirus pandemic.
Design: Retrospective chart review.
Setting: Outpatient visits (in-person, telephone, virtual-Doxy.me) over a 7-week period at a Level I Trauma Center orthopaedic clinic.
Intervention: Virtual visits utilizing the Doxy.me platform.
Main Outcome Measures: Accessing at least 1 virtual visit ("Virtual") or having telephone or in-person visits only ("No virtual").
Methods: All outpatient visits (in-person, telephone, virtual) during a 7-week period were tracked. At the end of the 7-week period, the electronic medical record was queried for each of the 641 patients who had a visit during this period for the following variables: gender, ethnicity, race, age, payer source, home zip code. Data were analyzed for both the total number of visits (n = 785) and the total number of unique patients (n = 641). Patients were identified as accessing at least 1 virtual visit ("Virtual") or having telephone or in-person visits only ("No virtual").
Results: Weekly totals demonstrated a rapid increase from 0 to greater than 50% virtual visits by the third week of quarantine with sustained high rates of virtual visits throughout the study period. Hispanic and Black/African American patients were able to access virtual care at similar rates to White/Caucasian patients. Patients of ages 65 to 74 and 75+ accessed virtual care at lower rates than patients ≤64 ( P  = .003). No difference was found in rates of virtual care between payer sources. A statistically significant difference was found between patients from different zip codes ( P  = .028).
Conclusion: A rapid transition to virtual clinic can be performed at a level 1 trauma center, and high rates of virtual visits can be maintained. However, disparities in access exist and need to be addressed.
Competing Interests: Michael Bosse reports stock ownership in an orthopaedic implant company and grant funding from the Department of Defense. Joseph Hsu reports consultancy for Globus Medical and personal fees from Smith & Nephew speakers' bureau. All other authors do not have any conflicts of interest to disclose.
(Copyright © 2021 The Authors. Published by Wolters Kluwer Health, Inc. on behalf of the Orthopaedic Trauma Association.)