TY - JOUR
T1 - Disparities in Telemedicine Use for Subspecialty Diabetes Care During COVID-19 Shelter-In-Place Orders
AU - Haynes, Sarah C.
AU - Kompala, Tejaswi
AU - Neinstein, Aaron
AU - Rosenthal, Jennifer
AU - Crossen, Stephanie
N1 - Funding Information:
The author(s) disclosed receipt of the following financial support for the research, authorship, and/or publication of this article: This project was funded by a research award from the Children’s Miracle Network in association with UC Davis Children’s Hospital.
Funding Information:
Dr Crossen receives support from the National Institute for Diabetes and Digestive and Kidney Diseases, National Institutes of Health, through grant number K23DK125671. Dr. Rosenthal receives support from the Eunice Kennedy Shriver National Institute of Child Health and Human Development, National Institutes of Health, through grant number K23HD101550. The content of this manuscript is solely the responsibility of the authors and does not necessarily represent the official views of the NIH.
Publisher Copyright:
© 2021 Diabetes Technology Society.
PY - 2021
Y1 - 2021
N2 - Background: During the COVID-19 pandemic, telemedicine use rapidly and dramatically increased for management of diabetes mellitus. It is unknown whether access to telemedicine care has been equitable during this time. This study aimed to identify patient-level factors associated with adoption of telemedicine for subspecialty diabetes care during the pandemic. Methods: We conducted an explanatory sequential mixed-methods study using data from a single academic medical center. We used multivariate logistic regression to explore associations between telemedicine use and demographic factors for patients receiving subspecialty diabetes care between March 19 and June 30, 2020. We then surveyed a sample of patients who received in-person care to understand why these patients did not use telemedicine. Results: Among 1292 patients who received subspecialty diabetes care during the study period, those over age 65 were less likely to use telemedicine (OR: 0.34, 95% CI: 0.22-0.52, P <.001), as were patients with a primary language other than English (OR: 0.53, 95% CI: 0.31-0.91, P =.02), and patients with public insurance (OR: 0.64, 95% CI: 0.49-0.84, P =.001). Perceived quality of care and technological barriers were the most common reasons cited for choosing in-person care during the pandemic. Conclusions: Our findings suggest that, amidst the COVID-19 pandemic, there have been disparities in telemedicine use by age, language, and insurance for patients with diabetes mellitus. We anticipate telemedicine will continue to be an important care modality for chronic conditions in the years ahead. Significant work must therefore be done to ensure that telemedicine services do not introduce or widen population health disparities.
AB - Background: During the COVID-19 pandemic, telemedicine use rapidly and dramatically increased for management of diabetes mellitus. It is unknown whether access to telemedicine care has been equitable during this time. This study aimed to identify patient-level factors associated with adoption of telemedicine for subspecialty diabetes care during the pandemic. Methods: We conducted an explanatory sequential mixed-methods study using data from a single academic medical center. We used multivariate logistic regression to explore associations between telemedicine use and demographic factors for patients receiving subspecialty diabetes care between March 19 and June 30, 2020. We then surveyed a sample of patients who received in-person care to understand why these patients did not use telemedicine. Results: Among 1292 patients who received subspecialty diabetes care during the study period, those over age 65 were less likely to use telemedicine (OR: 0.34, 95% CI: 0.22-0.52, P <.001), as were patients with a primary language other than English (OR: 0.53, 95% CI: 0.31-0.91, P =.02), and patients with public insurance (OR: 0.64, 95% CI: 0.49-0.84, P =.001). Perceived quality of care and technological barriers were the most common reasons cited for choosing in-person care during the pandemic. Conclusions: Our findings suggest that, amidst the COVID-19 pandemic, there have been disparities in telemedicine use by age, language, and insurance for patients with diabetes mellitus. We anticipate telemedicine will continue to be an important care modality for chronic conditions in the years ahead. Significant work must therefore be done to ensure that telemedicine services do not introduce or widen population health disparities.
KW - COVID-19
KW - diabetes mellitus
KW - health disparities
KW - telemedicine
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U2 - 10.1177/1932296821997851
DO - 10.1177/1932296821997851
M3 - Article
C2 - 33719622
AN - SCOPUS:85102490922
JO - Journal of diabetes science and technology
JF - Journal of diabetes science and technology
SN - 1932-2968
ER -