Disparities in Utilization of Outpatient Telemedicine for Neurologic Care

To characterize outpatient telemedicine utilization for neurologic conditions and identify potential disparities.

All outpatient visits conducted by neurology clinicians at an academic medical health care system for patients aged 18 years or older from January 2019 to July 2022 were included. All telemedicine visits were synchronous audio-visual. Patients completing in-person visits alone were compared with patients completing telemedicine visits. Utilization of telemedicine was compared across 3 time frames: prepandemic (before March 2020), early-pandemic (March-June 2020), and late-pandemic (July 2020-July 2022). Generalized linear mixed-effects models were used to evaluate whether the odds of a visit being telemedicine vs in-person differed based on the time frame and to predict likelihood of telemedicine vs in-person visit in late pandemic time frame.

In total, 242,273 patients (mean age 55.9 years, 58.2% female, 81.9% White, 12.5% Black, 3.4% Hispanic, 39.2% Medicare) completed 752,174 visits during the study time frame. There was a significant difference in telemedicine utilization between the time frames, with the highest utilization being in the early pandemic (p 0.01). In the late pandemic time frame, odds of a telemedicine visit were significantly lower for individuals who were older (odds ratio [OR] 0.97), Black (OR 0.84), Hispanic (OR 0.70), a higher Area Deprivation Index (20%-40%: OR 0.85, 40%-60%: OR 0.80, 60%-80%: OR 0.78, ≥80%: OR 0.65), with nonprivate insurance (Medicaid OR 0.78; Medicare OR 0.84; self-pay OR 0.60), and non-English preferred language (OR 0.61) (p < 0.01 for all). Odds of a telemedicine visit were significantly higher for individuals who were female (OR 1.25) and lived outside of the greater Cleveland area (other Ohio OR 2.33; out of state OR 3.32) (p < 0.01). Visits completed by rural patients did not differ significantly from metropolitan patients (OR 0.95, p = 0.09).

Disparities in telemedicine persist with lower use in individuals who were older, Black, Hispanic, non-English preferred language, and lower socioeconomic status. These disparities improved initially but were accentuated later in the pandemic. The equal utilization of telemedicine by rural and urban patients in this study suggests the potential of telemedicine to improve access disparities for rural patients. The implementation of equitable health care delivery will require a better understanding of barriers, preferences, and legislation needed to support equitable telemedicine access.