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Telemedicine use among primary care patients with diabetes varied by health system, with audio options linked to greater equity across racial and ethnic groups.

New research on primary care patients with diabetes during COVID-19 found inequities in telemedicine use varied across health systems with differing telemedicine implementation, reported researchers in the Journal of Medical Internet Research.

Jonathan J. Shih and colleagues described patients who used telemedicine during the pandemic and identified predictors of telemedicine across two independent health systems in California. The academic health system relied on video telemedicine and the safety net system delivered telemedicine via audio.

They conducted a retrospective cohort study of adults with diabetes receiving primary care from July 1, 2020, to March 31, 2022, at one of the health systems. The researchers derived patients’ sociodemographic characteristics, health medicine, and telemedicine use from EHRs. The primary endpoint was visit type (any audio or video telemedicine vs in-person only) during the study period.

The analysis included 10,201 adult patients with diabetes, of whom 81% had at least one telemedicine visit during the study period. After adjusting for key predictors and covariates, the investigators found that patients in the safety net system had higher odds of telemedicine use compared with the academic system (adjusted odds ratio [aOR], 2.94; 95% CI, 2.48-3.48). Patients aged 18-24 and 35-49 years also had a greater likelihood of a telemedicine visit versus patients older than 75 years (aOR, 2.55; 95% CI, 1.63-3.97 and aOR, 1.39; 95% CI, 1.12-1.73). Additionally, patients with Chinese-language preference (aOR, 2.04; 95% CI, 1.66-2.5 vs English) had a higher probability of a telemedicine visit. Non-Hispanic Asian (aOR, 0.67; 95% CI, 0.56-0.79), non-Hispanic Black (aOR, 0.83; 95% CI, 0.68-1), and Hispanic or Latine (aOR, 0.76; 95% CI, 0.61-0.95) patients had lower odds of a telemedicine visit than non-Hispanic White patients.

After stratifying by health system, they observed lower telemedicine use among older patients and minoritized racial and ethnic groups in the academic health system—disparities that were not seen in the safety net system, which serves a more diverse population. In the academic system, non-Hispanic Asian (aOR, 0.57; 95% CI, 0.46-0.70) and Latine (aOR, 0.67; 95% CI, 0.50-0.91) patients had reduced odds of a telemedicine visit, and younger age groups had higher odds (18-34 years: aOR, 3.97; 95% CI, 1.99-7.93; 35-49 years: aOR, 1.86; 95% CI, 1.36-2.56).

“Our findings suggest that rapid, widespread telemedicine implementation prioritizing video telemedicine may exacerbate disparities in telemedicine utilization. Providing both audio-only and video appointments may enhance accessibility to care for populations historically at risk for digital exclusion,” the authors wrote.