Differences in Telemedicine Use for Patients With Diabetes in an Academic Versus Safety Net Health System:...

Area of Science:

• Health Informatics
• Health Services Research
• Digital Health Equity

Background:

• The COVID-19 pandemic accelerated telemedicine adoption, revealing disparities in access based on age, race, ethnicity, and language.
• Previous research has not fully explored how health system implementation strategies influence these telemedicine inequities.

Purpose of the Study:

• To characterize patients utilizing telemedicine during the public health emergency.
• To identify predictors of telemedicine use across two distinct health system implementation models.

Main Methods:

• Retrospective cohort study of adults with diabetes in San Francisco (July 2020-March 2021).
• Analysis of electronic health records to compare telemedicine (audio/video) vs. in-person visits.
• Multivariable logistic regression assessed predictors of telemedicine use, including age, race, ethnicity, language, and socioeconomic status, with health system interaction.

Main Results:

• Telemedicine use was higher in the safety-net system (prioritizing audio-only) compared to the academic system (prioritizing video).
• Younger patients and Chinese-language speakers had higher odds of telemedicine use. Non-Hispanic Asian, Black, and Hispanic/Latine patients had lower odds compared to White patients.
• Significant interactions showed disparities varied by health system: academic system had lower use among Asian and Latine patients and higher use in younger groups; safety-net system showed higher use among Chinese speakers.

Conclusions:

• Significant disparities in telemedicine utilization exist, influenced by age, race, ethnicity, and language, particularly within video-centric health systems.
• Certain populations face digital exclusion risks despite rapid telemedicine expansion.
• System-level implementation decisions critically affect telemedicine accessibility for vulnerable patient groups.