Telehealth closed racial gap in completed doctor visits during pandemic

Telehealth could be a “potential long-term tool for equity” for Black patients in primary care, according to a new study.

When COVID-19 caused medical office closures in 2020, online services rose sharply and closed gaps in health care access for Black patients in the Penn Medicine system around Philadelphia, Pennsylvania. When “normal” in-office visits resumed, historic inequities stayed erased, according to researchers at the Perelman School of Medicine at the University of Pennsylvania.

“We looked through the entire year of 2020, not just the first half of the year when telemedicine was the only option for many people, and the appointment completion gap between Black and non-Black patients closed,” senior author, Krisda Chaiyachati, MD, said in a press release.

“Offering telemedicine, even though it was for a crisis, appears to have been a significant step forward toward addressing long-standing inequities in healthcare access,” said Chaiyachati, an assistant professor Medicine at Penn Medicine and the physician lead for Value-based Care and Innovation at Verily. Chaiyachati also headed Penn Medicine OnDemandvirtual visit service through most of the pandemic.

The findings were published in the journal Telemedicine and e-Health.

The researchers analyzed data from about 1 million appointments a year for Black and non-Black patients in 2019 and 2020, including examination of four distinct time periods within 2020: prepandemic, from January to March 12; shutdown, when stay-at-home orders were in place March 13 to June 3; reopening, when stay-at-home orders were lifted June 4 to September; and second wave, when cases surged October through December.

Completed primary care visits rose from about 60% among Black patients before the arrival of COVID-19, to more than 80% in 2020. For non-Black patients, the visit completion rate was about 70% prior to the pandemic, then more than 80% in 2020.

“The equity gap of at least 10% disappeared at Penn Medicine practices after the pandemic arrived, when telemedicine was widely adopted,” the study said.

Overall, the total number of primary care visits declined in 2020 compared to 2019 due to pandemic shutdowns and reluctance among the public to be seen in person. Total telehealth appointments rose in 2020, compared to the year before.

Data showed, proportionately, about 33% of Black patients’ appointments were completed using telehealth, while 25% of non-Black patients used telehealth for appointments in 2020. The year before, rates for both groups were below a tenth of 1%, according to the study.

The researchers acknowledged there was concern at the start of the pandemic that introducing telemedicine might deepen access problems for patients. But they said the study adds to evidence that may not be the case, at least for primary care.

“As the health care sector – policymakers, payers, providers, and patients – continue to develop the role telemedicine may play in health care’s future, understanding how it can be a mechanism for improving equity is an important dimension to consider,” Chaiyachati said.