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Research ArticleOriginal Research

Use of Telehealth Early and Late in the COVID-19 Public Health Emergency: Policy Implications for Improving Health Equity

Katherine Sanchez, Heather Kitzman, Mahbuba Khan, Briget da Graca, Jeffrey Zsohar and Frank McStay
The Journal of the American Board of Family Medicine October 2023, 36 (5) 746-754; DOI: https://doi.org/10.3122/jabfm.2023.230080R1
Katherine Sanchez
From the Baylor Scott & White Research Institute, Dallas, TX (KS, MK, BDG); UT Southwestern Medical Center, Peter O’Donnell Jr. School of Public Health, Dallas, TX (HK); Baylor Scott & White Community Care Clinics (JZ); Duke-Margolis Center for Health Policy, Duke University (FM).
PhD
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Heather Kitzman
From the Baylor Scott & White Research Institute, Dallas, TX (KS, MK, BDG); UT Southwestern Medical Center, Peter O’Donnell Jr. School of Public Health, Dallas, TX (HK); Baylor Scott & White Community Care Clinics (JZ); Duke-Margolis Center for Health Policy, Duke University (FM).
PhD
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Mahbuba Khan
From the Baylor Scott & White Research Institute, Dallas, TX (KS, MK, BDG); UT Southwestern Medical Center, Peter O’Donnell Jr. School of Public Health, Dallas, TX (HK); Baylor Scott & White Community Care Clinics (JZ); Duke-Margolis Center for Health Policy, Duke University (FM).
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Briget da Graca
From the Baylor Scott & White Research Institute, Dallas, TX (KS, MK, BDG); UT Southwestern Medical Center, Peter O’Donnell Jr. School of Public Health, Dallas, TX (HK); Baylor Scott & White Community Care Clinics (JZ); Duke-Margolis Center for Health Policy, Duke University (FM).
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Jeffrey Zsohar
From the Baylor Scott & White Research Institute, Dallas, TX (KS, MK, BDG); UT Southwestern Medical Center, Peter O’Donnell Jr. School of Public Health, Dallas, TX (HK); Baylor Scott & White Community Care Clinics (JZ); Duke-Margolis Center for Health Policy, Duke University (FM).
MD
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Frank McStay
From the Baylor Scott & White Research Institute, Dallas, TX (KS, MK, BDG); UT Southwestern Medical Center, Peter O’Donnell Jr. School of Public Health, Dallas, TX (HK); Baylor Scott & White Community Care Clinics (JZ); Duke-Margolis Center for Health Policy, Duke University (FM).
MPA
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Article Figures & Data

Tables

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    Table 1.

    Characteristics of Primary Care Patients During the Early Months of COVID-19 (March 23, 2020–June 22, 2020) and Late COVID-19 (March 23, 2022–June 22, 2022) in Practices Serving Primarily Commercially Insured Patients and Clinics Serving Low-Income, Un-/Underinsured Patients

    Early COVID-19Late COVID-19
    CommercialUninsuredCommercialUninsured
    VariablesCategoriesMean (SD)/ N (%)Mean (SD)/ N (%)Mean (SD)/ N (%)Mean (SD)/ N (%)
    N1,47,65740861,38,0404094
    Age, mean (SD)55.37 (17.51)50.60 (12.47)55.57 (17.50)52.67 (12.21)
    Sex, N (%)Female88,616 (60.01)2682 (65.64)82,863 (60.03)2661 (65.00)
    Male59,037 (39.98)1404 (34.36)55,166 (39.96)1433 (35.00)
    Race/ethnicity, N (%)White97,088 (65.75)454 (11.11)88,433 (64.06)384 (9.38)
    Black20,054 (13.58)857 (20.97)18,050 (13.08)787 (19.22)
    Hispanic17,684 (11.98)2656 (65.0)18,025 (13.06)2827 (69.05)
    Other7148 (4.84)86 (2.10)8439 (6.11)71 (1.73)
    Unknown5683 (3.85)33 (0.81)5093 (3.69)25 (0.61)
    Type of Insurance, N (%)Uninsured/Self-Pay16,821 (11.39)3162 (77.39)17,034 (12.34)3108 (75.92)
    Unknown1391 (0.94)109 (2.67)996 (0.72)76 (1.86)
    Government/Private1,29,445 (87.67)815 (19.95)1,20,010 (86.94)910 (22.23)
    Patients with diabetes, N (%)Yes33,514 (22.7)1840 (45.03)30,498 (22.09)2019 (49.32)
    No1,14,143 (77.3)2246 (54.97)1,07,542 (77.91)2075 (50.68)
    Patients with hypertension, N (%)Yes76,190 (51.6)1998 (48.9)74,310 (53.83)2191 (53.52)
    No71,467 (48.4)2088 (51.1)63,730 (46.17)1903 (46.48)
    • Abbreviation: SD, Standard deviation.

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    Table 2.

    Primary Care Visits by Mode of Visit During the Early Months of COVID-19 (March 23, 2020–June 22, 2020) and Late COVID-19 (March 23, 2022–June 22, 2022) for Practices Serving Primarily Commercially Insured Patients and Clinics Serving Low-Income, Un-/Under-insured Patients

    Early COVID-19Late COVID-19
    Visit TypeCommercial, N (%)Uninsured, N (%)Commercial, N (%)Uninsured, N (%)
    Office visit62,734 (32.76)1298 (23.55)1,39,510 (81.05)5251 (92.04)
    Phone visit24,385 (12.74)3123 (56.67)1028 (0.6)116 (2.03)
    Video Visit1,04,349 (54.5)1090 (19.78)31,581 (18.35)338 (5.92)
    Total1,91,46855111,72,1195705
    • View popup
    Table 3.

    Primary Care Patient Characteristics by Visit Type During the Early Months of COVID-19 (March 23, 2020–June 22, 2020)

    Office Visit, N (%)Phone Visit, N (%)Video Visit, N (%)
    Demographic VariablesCategoriesCommercialUninsuredCommercialUninsuredCommercialUninsuredp-Value*
    Age group18 to 4415,902 (29.00)362 (21.31)4424 (8.07)895 (52.68)34,508 (62.93)442 (26.02)<0.0001
    45 to 5410,679 (31.78)433 (24.99)3180 (9.46)962 (55.51)19,741 (58.75)338 (19.5)
    55 to 6412,948 (34.3)368 (24.27)4506 (11.94)913 (60.22)20,290 (53.76)235 (15.5)
    >=6523,205 (35.54)135 (23.98)12,275 (18.8)353 (62.7)29,810 (45.66)75 (13.32)
    SexFemale36,187 (30.97)873 (23.65)15,663 (13.41)2094 (56.73)64,983 (55.62)724 (19.62)0.0004
    Male26,545 (35.57)425 (23.35)8720 (11.68)1029 (56.54)39,365 (52.75)366 (20.11)
    Unknown2 (40)–2 (40)–1 (20)–
    Race/ ethnicityWhite41,276 (32.97)124 (18.76)15,729 (12.56)378 (57.19)68,199 (54.47)159 (24.05)0.0001
    Black8376 (31.25)273 (23.51)4060 (15.15)657 (56.59)14,365 (53.6)231 (19.9)
    Hispanic8007 (34.26)864 (24.57)2939 (12.57)2006 (57.04)12,426 (53.17)647 (18.4)
    Other3007 (33.31)26 (20.8)827 (9.16)61 (48.8)5192 (57.52)38 (30.4)
    Unknown2068 (29.27)11 (23.4)830 (11.75)21 (44.68)4167 (58.98)15 (31.91)
    Type of InsuranceSelf-pay6860 (31.27)1026 (24.34)2824 (12.87)2360 (55.98)12,251 (55.85)830 (19.69)0.0038
    Unknown615 (32.66)28 (17.61)281 (14.92)91 (57.23)987 (52.42)40 (25.16)
    Government/Private55,259 (32.96)244 (21.48)21,280 (12.69)672 (59.15)91,111 (54.35)220 (19.37)
    • ↵Note: *p-value was estimated from multinomial logistic regression where dependent variable was type of visit and the reported p-value was from the significance of the interaction term between the group and corresponding socio-economic variable after adjusted for Bonferroni due to multiple testing. As four tests were performed, the adjusted alpha was 0.0125.

    • View popup
    Table 4.

    Primary Care Patient Characteristics by Visit Type for Late COVID-19 (March 23, 2022–June 22, 2022)

    Office Visit, N (%)Phone Visit, N (%)Video Visit, N (%)
    Demographic VariablesCategoriesCommercialUninsuredCommercialUninsuredCommercialUninsuredp-Value*
    Age group18 to 4436,378 (73.2)1264 (90.74)127 (0.26)36 (2.58)13,193 (26.55)93 (6.68)<0.0001
    45 to 5423,120 (79.67)1687 (91.83)91 (0.31)26 (1.42)5808 (20.01)124 (6.75)
    55 to 6427,735 (83.77)1573 (92.31)153 (0.46)40 (2.35)5220 (15.77)91 (5.34)
    >=6552,277 (86.7)727 (94.29)657 (1.09)14 (1.82)7360 (12.21)30 (3.89)
    SexFemale83,250 (79.55)3462 (91.78)673 (0.64)82 (2.17)20,727 (19.81)228 (6.04)0.3004
    Male56,250 (83.39)1789 (92.55)355 (0.53)34 (1.76)10,850 (16.08)110 (5.69)
    Unknown10 (71.43)–0 (0)–4 (28.57)–
    Race/ ethnicityWhite89,215 (80.53)474 (86.03)780 (0.70)11 (2.00)20,785 (18.76)66 (11.98)<0.0001
    Black18,520 (81.67)1019 (92.13)107 (0.47)9 (0.81)4049 (17.86)78 (7.05)
    Hispanic18,637 (83.47)3640 (92.95)89 (0.4)93 (2.37)3601 (16.13)183 (4.67)
    Other8226 (80.32)85 (87.63)25 (0.24)3 (3.09)1991 (19.44)9 (9.28)
    Unknown4912 (80.6)33 (94.29)27 (0.44)0 (0)1155 (18.95)2 (5.71)
    Type of InsuranceSelf-pay16,771 (78.6)4001 (92.3)148 (0.69)98 (2.26)4418 (20.71)236 (5.44)0.0001
    Unknown1080 (81.39)101 (98.06)12 (0.9)0 (0)235 (17.71)2 (1.94)
    Government/Private1,21,659 (81.4)1149 (90.69)868 (0.58)18 (1.42)26,928 (18.02)100 (7.89)
    • Note: *p-value was estimated from multinomial logistic regression where dependent variable was type of visit and the reported p-value was from the significance of the interaction term between the group and corresponding socio-economic variable after adjusted for Bonferroni due to multiple testing. As four tests were performed, the adjusted alpha was 0.0125.

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The Journal of the American Board of Family     Medicine: 36 (5)
The Journal of the American Board of Family Medicine
Vol. 36, Issue 5
September-October 2023
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Use of Telehealth Early and Late in the COVID-19 Public Health Emergency: Policy Implications for Improving Health Equity
Katherine Sanchez, Heather Kitzman, Mahbuba Khan, Briget da Graca, Jeffrey Zsohar, Frank McStay
The Journal of the American Board of Family Medicine Oct 2023, 36 (5) 746-754; DOI: 10.3122/jabfm.2023.230080R1

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Use of Telehealth Early and Late in the COVID-19 Public Health Emergency: Policy Implications for Improving Health Equity
Katherine Sanchez, Heather Kitzman, Mahbuba Khan, Briget da Graca, Jeffrey Zsohar, Frank McStay
The Journal of the American Board of Family Medicine Oct 2023, 36 (5) 746-754; DOI: 10.3122/jabfm.2023.230080R1
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