Published on in Vol 8, No 1 (2022): Jan-Dec

Preprints (earlier versions) of this paper are available at https://preprints.jmir.org/preprint/39264, first published .
Examining the Use of Telehealth During the COVID-19 Pandemic Among Patients With Type 2 Diabetes at a Federally Qualified Health Center

Examining the Use of Telehealth During the COVID-19 Pandemic Among Patients With Type 2 Diabetes at a Federally Qualified Health Center

Examining the Use of Telehealth During the COVID-19 Pandemic Among Patients With Type 2 Diabetes at a Federally Qualified Health Center

Abstract

1San Diego State University, San Diego, CA, United States

2Family Health Centers of San Diego, Inc, San Diego, CA, United States

Corresponding Author:

Emily Schmied, MPH, PhD

San Diego State University

5500 Campanile Dr.

San Diego, CA, 92182

United States

Phone: 1 4254170884

Email: eschmied@sdsu.edu


Background: The COVID-19 pandemic necessitated an expedited shift toward remote health care delivery (eg, telehealth). Prior research has shown individuals from underserved communities may face greater challenges accessing telehealth services, which could exacerbate existing disparities in chronic conditions, including type 2 diabetes (T2D). As patient engagement in telehealth care is likely to persist indefinitely, it is critical to determine whether certain patients may face greater challenges in accessing remote care so that appropriate accommodations can be made.

Objective: This study aimed to examine factors associated with the use of telehealth during the COVID-19 pandemic among adults with T2D at a large federally qualified health center in Southern California.

Methods: Electronic health records (EHR) from all T2D-related medical visits completed between July 2019 and July 2021 were obtained. The following variables were extracted from the EHR: modality of visit (in person vs telehealth), patient gender (male, female, nonbinary, or transgender), age, race or ethnicity (non-Hispanic White, Hispanic, Black, Asian, Middle Eastern or Arab, Asian-Pacific Islander, Native American or Alaskan, or multiracial), and income level (below or at vs above the poverty threshold). Patients were trichotomized based on whether they completed at least one telehealth visit following the start of the pandemic, if they completed all visits in person, or if they completed no visits. Chi-square analysis and t tests were conducted to examine univariate group differences. Multinomial logistic regression was conducted to examine associations between telehealth use and patient sociodemographics.

Results: Participants included 14,989 patients with T2D (51.7% female, 48.1% male, and 0.2% transgender or nonbinary; 83.7% below or at the poverty threshold). Over half (59.0%) of patients completed at least one T2D-related telehealth visit, 27.6% completed only in-person visits, and 13.4% complete no visits after the start of the pandemic. Compared to male (54.9%) and transgender or nonbinary patients (52.8%), significantly more females used telehealth (62.8%; χ2=100.89, P<.001). Significant differences also emerged between racial and ethnic groups, with the highest engagement among Middle Eastern or Arab (66.8%) and Hispanic patients (60.7%) and the lowest among Asian-Pacific Islander (50.0%) and Native American or Alaskan patients (52.2%; χ2=72.33, P<.001). Multinomial regression analysis revealed that women (odds ratio [OR] 1.29, 95% CI 1.17-1.42), Hispanic patients (OR 1.56, 95% CI 1.06-2.30), and Arab patients (OR 2.22, 95% CI 1.32-3.76) were more likely to complete telehealth visits rather than no visits than male patients and those of all other racial and ethnic groups. Similarly, women (OR 1.42, 95% CI 1.33-1.54) and Arab patients (OR 1.62, 95% CI 1.08-2.43) were more likely to complete telehealth than in-person visits. No significant differences by age or income were identified.

Conclusions: While many patients accessed telehealth during the pandemic, observed differences by sociodemographic characteristics suggest that some patients may require additional support when accessing remote health care. Future research should explore additional factors that could impact telehealth access within underserved communities (eg, internet or broadband access, language concordance, and technology literacy) so that tailored strategies can be developed to facilitate equitable access to care.

Conflicts of Interest: None declared.

iproc 2022;8(1):e39264

doi:10.2196/39264

Keywords


Edited by S Pagoto; This is a non–peer-reviewed article. submitted 04.05.22; accepted 01.06.22; published 09.06.22

Copyright

©Emily Schmied, Sara Gombatto, Jessica Priest, Victoria Briese, Jie Liu. Originally published in Iproceedings (https://www.iproc.org), 09.06.2022.

This is an open-access article distributed under the terms of the Creative Commons Attribution License (https://creativecommons.org/licenses/by/4.0/), which permits unrestricted use, distribution, and reproduction in any medium, provided the original work, first published in Iproceedings, is properly cited. The complete bibliographic information, a link to the original publication on https://www.iproc.org/, as well as this copyright and license information must be included.