Introduction: The COVID-19 pandemic has accelerated the adoption of telemedicine, defined as the real-time, interactive delivery of healthcare information electronically, particularly within urology. However, literature has found that elderly and Black patients are less likely to complete or prefer a tele-health visit. This study aims to understand the impact of various socio-demographic factors on patterns in tele-health usage after the first wave of the COVID-19 pandemic among all surgical specialties and within urology specifically.
Methods: Data on race, ethnicity, type of visit, visit method, language preference, and insurance type was extracted directly from visit information for all surgical specialty visits at the Brigham and Women’s Hospital from five three-month time periods in 2019 and 2020. Variables were re-coded to fit a binary outcome for each. Chi-square tests were performed for univariable analysis. A difference-in-differences regression model controlling for time-invariable cofactors was used to examine the effect of each variable on the change in proportion of virtual visits between all possible pairs of time periods. Our exposure variables of interest were Black race, status as Medicare beneficiary, and preference for non-English language with control variables of White race, non-Medicare beneficiary, and primarily English-speaking status, respectively. All analysis was performed in R.
Results: Our dataset included a total of 182,074 surgical specialty visits. Although total visits decreased during the pandemic period, total visits before and after the first-wave period were comparable. When compared to White patients, the proportion of virtual visits for Black patients after the first wave was 8.3% higher than expected among all surgical specialties, but 7.3% lower than expected within only urology visits (p < 0.01). When compared to non-Medicare beneficiaries, the proportion of virtual visits for Medicare beneficiaries after the first wave was about 6% lower than expected across all surgical specialties and urology only (p < 0.01). When compared to English-speaking patients, the proportion of virtual visits for non-English speaking patients after the first wave was 4% less than expected among all specialties and 12% less than expected among urology only (p < 0.01).
Conclusions: Usage of tele-health by Black patients, Medicare beneficiaries, and non-English speaking patients is lower than expected in urology. Understanding disparities in tele-health usage may help inform policy that could alleviate inequities in access to urologic care.