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Research ArticleOriginal Research

Associations between Patient- and Provider Level Factors, and Telemedicine Use in Family Medicine Clinics

Omolola E. Adepoju, Luan Tran, Rosemary Agwuncha, Minji Chae, Jason Franco-Castano, Tracy Angelocci and Winston Liaw
The Journal of the American Board of Family Medicine May 2022, 35 (3) 457-464; DOI: https://doi.org/10.3122/jabfm.2022.03.210416
Omolola E. Adepoju
From University of Houston College of Medicine, Houston, TX (OA, LT, RA, WL); Humana Integrated Health System Sciences Institute at the University of Houston, Houston, TX (OA, MC, JFC); Lone Star Circle of Care, Georgetown, TX (TA).
PhD, MPH
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Luan Tran
From University of Houston College of Medicine, Houston, TX (OA, LT, RA, WL); Humana Integrated Health System Sciences Institute at the University of Houston, Houston, TX (OA, MC, JFC); Lone Star Circle of Care, Georgetown, TX (TA).
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Rosemary Agwuncha
From University of Houston College of Medicine, Houston, TX (OA, LT, RA, WL); Humana Integrated Health System Sciences Institute at the University of Houston, Houston, TX (OA, MC, JFC); Lone Star Circle of Care, Georgetown, TX (TA).
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Minji Chae
From University of Houston College of Medicine, Houston, TX (OA, LT, RA, WL); Humana Integrated Health System Sciences Institute at the University of Houston, Houston, TX (OA, MC, JFC); Lone Star Circle of Care, Georgetown, TX (TA).
MS
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Jason Franco-Castano
From University of Houston College of Medicine, Houston, TX (OA, LT, RA, WL); Humana Integrated Health System Sciences Institute at the University of Houston, Houston, TX (OA, MC, JFC); Lone Star Circle of Care, Georgetown, TX (TA).
MS
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Tracy Angelocci
From University of Houston College of Medicine, Houston, TX (OA, LT, RA, WL); Humana Integrated Health System Sciences Institute at the University of Houston, Houston, TX (OA, MC, JFC); Lone Star Circle of Care, Georgetown, TX (TA).
MD
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Winston Liaw
From University of Houston College of Medicine, Houston, TX (OA, LT, RA, WL); Humana Integrated Health System Sciences Institute at the University of Houston, Houston, TX (OA, MC, JFC); Lone Star Circle of Care, Georgetown, TX (TA).
MD, MPH
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  • Article
  • Figures & Data
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Article Figures & Data

Tables

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    Table 1.

    Unique Patient Baseline Characteristics (n = 37,428)

    Total
    VariablesN(%)
    Age
        < 181891(5.1)
        18 to 6432,759(87.5)
        > 642778(7.4)
    Sex
        Female24,983(66.8)
        Male12,445(33.2)
    Race/ethnicity
        Hispanic20,109(57.1)
        Non-Hispanic White9916(28.1)
        Non-Hispanic Black3630(10.3)
        Asian1142(3.2)
        Other165(0.5)
        Mixed race280(0.8)
    Insurance coverage
        Private insurance7317(19.8)
        Medicare21,195(57.3)
        Medicaid3065(8.3)
        Uninsured5441(14.7)
    Metropolitan status of patient residence
        Nonmetropolitan1758(4.7)
        Metropolitan35,658(95.3)
    MUA status of patient residence
        Non-MUA20,779(55.5)
        MUA16,637(44.5)
    Commute time to clinic
        0 to 10 minutes10,051(26.9)
        11 to 20 minutes14,588(39.0)
        21 to 30 minutes7873(21.0)
        30 to 300 minutes4916(13.1)
    Provider characteristics (n = 42)
        Provider type
            Non-MD (APRN, FNP, PAC)23(54.8)
            MD19(25.2)
        Provider language
            English only26(61.9)
            English and Spanish16(38.1)
        Years in practice
            0 to 5 years7(16.6)
            6 to 10 years12(28.6)
            11 to 20 years12(28.6)
            21 + years11(26.2)
    • Abbreviations: APRN, advanced practice registered nurse; FNP, family nurse practitioner; MUA, medically underserved area; PAC, certified physician assistant.

    • View popup
    Table 2.

    Telehealth Use over Time (January 2020–November 2020)

    In-Person Appointment (n = 81,296)Telehealth Appointment (n = 25,309)
    MonthNRate (%)NRate (%)
    January 202011,08710020
    February 202010,42910020
    March 202010,222973613
    April 2020476163280737
    May 2020499261317839
    June 2020679864376436
    July 2020708564391736
    August 2020687069304231
    September 2020650469295631
    October 2020666771268629
    November 2020588169259431
    • View popup
    Table 3.

    Mixed-Effects Logistic Regression Model of the Relationship Between Telehealth Use in Family Practice Clinics, Patient and Provider Characteristics

    MV-Adjusted OR
    VariablesOR95%CIP value
    Patient characteristics
        Age
            18 to 64Ref.
            <180.220.19-0.260.001
            >650.890.81-0.980.013
        Sex
            FemaleRef.
            Male1.010.871.030.87
        Race/ethnicity
            HispanicRef.
            Non-Hispanic White1.611.53-1.690.001
            Non-Hispanic Black1.371.27-1.470.001
            Asian1.050.92-1.200.920
            Other1.310.951.810.097
            Mixed race1.881.50-2.360.001
        Insurance coverage
            Private insuranceRef.
            Medicare0.910.83-1.010.068
            Medicaid1.030.96-1.120.068
            Uninsured0.810.77-0.860.001
        Metropolitan status
            NonmetropolitanRef.
            Metropolitan1.251.08-1.460.004
        MUA status
            Non-MUARef.
            MUA1.191.13-1.270.001
        Commute time to clinic
            0 to 10 minutesRef.
            11 to 20 minutes1.040.99-1.100.135
            21 to 30 minutes1.141.07-1.210.001
            >30 minutes1.281.19-1.380.001
    Provider characteristics
        Provider type
            Non-MD (APRN, FNP, PAC)Ref.
            MD1.050.64-1.730.86
        Provider language
            English onlyRef.
            English and Spanish1.350.84-2.170.22
        Years in practice
            0 to 5 yearsRef.
            6 to 10 years1.780.93-3.410.08
            11 to 20 years1.420.73-2.780.30
            21 + years1.000.47-2.130.99
    Intraclass correlation coefficient for provider and patient random effects
            Variance estimate95% CIStd Err
    Patient (variance estimate, CI)0.310.26-0.380.21
    Patient | provider (variance estimate, CI)0.380.35-0.410.02
    • Abbreviations: MV-Adjusted OR, Multi-variable-adjusted odds ratio; CI, confidence interval; APRN, advanced practice registered nurse; FNP, family nurse practitioner; MUA, medically underserved area; PAC, certified physician assistant.

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The Journal of the American Board of Family Medicine: 35 (3)
The Journal of the American Board of Family Medicine
Vol. 35, Issue 3
May/June 2022
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Associations between Patient- and Provider Level Factors, and Telemedicine Use in Family Medicine Clinics
Omolola E. Adepoju, Luan Tran, Rosemary Agwuncha, Minji Chae, Jason Franco-Castano, Tracy Angelocci, Winston Liaw
The Journal of the American Board of Family Medicine May 2022, 35 (3) 457-464; DOI: 10.3122/jabfm.2022.03.210416

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Associations between Patient- and Provider Level Factors, and Telemedicine Use in Family Medicine Clinics
Omolola E. Adepoju, Luan Tran, Rosemary Agwuncha, Minji Chae, Jason Franco-Castano, Tracy Angelocci, Winston Liaw
The Journal of the American Board of Family Medicine May 2022, 35 (3) 457-464; DOI: 10.3122/jabfm.2022.03.210416
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Keywords

  • Electronic Health Records
  • Family Medicine
  • Health Services Accessibility
  • Logistic Models
  • Medically Underserved Area
  • Medically Uninsured
  • Primary Health Care
  • Retrospective Studies
  • Telemedicine

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