Medical Student Duke University Department of Neurosurgery Durham, North Carolina, United States
Introduction: COVID-19 led to the rapid uptake of telemedicine in the spine surgery patient population. However, this rise in usage may not be equally spread across the population as it is predicated on factors like internet accessibility and technologic literacy. This study aims to identify potential disparities in telemedicine utilization in the wake of COVID-19 and its aftermath for surgical spine patients.
Methods: A retrospective study of patients with a spine-related condition scheduled for surgery between the dates of June 12, 2018 and July 19, 2021 was performed. Patients were required to have at least one scheduled follow up visit, either virtual (video or telephone visit) or in-person. Binary socioeconomic variables used for modeling included: urbanicity (rural vs urban, defined by zip code), age at time of procedure (≥65 years vs < 65), sex (male vs female), race (non-White vs White), ethnicity (Hispanic vs non-Hispanic), language (non-English speaking vs English-speaking), primary insurer (no insurance/public insurance vs private insurance), and patient portal utilization (activated vs. not activated). Analyses were conducted for the entire cohort as well as separately for cohorts of patients who had visits scheduled within specific time frames of interest: Pre-COVID-19 surge (June 12, 2018 – March 16, 2020), initial COVID-19 surge (March 17, 2020 – April 24, 2020), and post-COVID-19 surge (April 25, 2020 – July 19, 2021).
Results: After adjusting for all other variables, patients that utilized the patient portal had higher odds of completing a video visit (OR: 5.21; 95% CI: 1.28, 21.23). Hispanic (OR: 0.44; 95% CI: 0.2, 0.98) and rural (OR: 0.58; 95% CI: 0.36, 0.93) patients had lower odds of completing a telephone visit.
Conclusion : The widespread expansion of telemedicine transformed the delivery of healthcare during the COVID-19 pandemic. This study demonstrates the disparity in its utilization across different populations and virtual platforms within the surgical spine patient population. Going forward, providers may use this information to take a more nuanced approach in deciding what type of visit to pursue with certain patient populations.
