Abstract Details

Title Minorities, Socioeconomic Disadvantaged, and Older Patients have Decreased Utilization of Telehealth for Neurological Conditions

Topic Health Care Disparities

Presentation(s) S29 - Health Care Disparities (3:54 PM-4:06 PM)

Poster/Presentation
Number 003

Background Telehealth has the potential to improve access to neurological care, but there is a need to understand telehealth utilization to ensure equitable healthcare delivery.

Objective

To characterize telehealth utilization for neurological conditions and identify potential disparities in utilization.

Design/Methods

All outpatient visits conducted by neurology clinicians at the Cleveland Clinic for patients ≥18 years from 7/2020 to 7/2022 were included. Patients with fully in-person care were compared to patients with a combination of telehealth and in-person care. Visits were analyzed using a generalized linear mixed effects model to predict telehealth or in person visit type, using fixed effects of age, race, ethnicity, gender, location, rural-urban commuting areas codes (RUCA), area deprivation index (ADI), insurance, provider, language, and visit completion, and random intercept of subjects. Significance was set at p<0.001.

Results 192,556 patients (mean age 54.8 years, 59.4% female, 80.1% white, 3.4% Hispanic, 37.6% Medicare, mean visits 7.4 ) completed a total of 584,900 visits during the study timeframe. In-person visits were completed by older (57.8 vs 49.4 years), higher ADI (23.0% vs 20.3% 4^th quartile), Black (12.3% vs 9.7%), Hispanic (3.2% vs 3.1%), male (41.2% vs 34.3%), local (72.2% vs 65.4%), metropolitan (85.8% vs 80.4%), and Medicare (45.5% vs 29.5%) individuals compared to telehealth visits. Odds of a visit being telehealth were significantly lower for older (OR 0.96), Black (OR 0.80), Hispanic (OR 0.79), higher ADI quartile (4^th quartile OR 0.62), Medicaid (OR 0.77), Medicare (OR 0.80), self-pay (0.48), micropolitan (OR 0.83), and non-English primary language (OR 0.35) patients.

Conclusions

The COVID-19 pandemic expanded access to telehealth care, but disparities remain in utilization most notable for older, Black, Hispanic, and lower socioeconomic status individuals. Efforts are needed to understand patient barriers and preferences to telehealth along with legislation needed to facilitate equitable healthcare delivery.

Authors/Disclosures
Marisa P. McGinley, DO (Cleveland Clinic) PRESENTER	Dr. McGinley has received personal compensation in the range of $500-$4,999 for serving as a Consultant for Octave. Dr. McGinley has received personal compensation in the range of $500-$4,999 for serving on a Scientific Advisory or Data Safety Monitoring board for Genentech. Dr. McGinley has received personal compensation in the range of $500-$4,999 for serving on a Scientific Advisory or Data Safety Monitoring board for EMD Serono. The institution of Dr. McGinley has received research support from Novartis. The institution of Dr. McGinley has received research support from Biogen. The institution of Dr. McGinley has received research support from Genentech. The institution of Dr. McGinley has received research support from NIH.
Tucker Harvey (Cleveland Clinic, LRI, Quantitative Health Sciences)	No disclosure on file
Allison L. Weathers, MD, FAAN (Cleveland Clinic)	Dr. Weathers has received personal compensation in the range of $500-$4,999 for serving as a CME question writer, interviewer, presenter with American Academy of Neurology. Dr. Weathers has a non-compensated relationship as a Chair, Neurology Adult Steering Board with Epic that is relevant to AAN interests or activities. Dr. Weathers has a non-compensated relationship as a Member of the Meeting Management Committee and Member of the Registry and Quality Informatics Subcommittees with American Academy of Neurology that is relevant to AAN interests or activities. Dr. Weathers has a non-compensated relationship as a Vice-Chair, Quality Informatics Subcommittee with American Academy of Neurology that is relevant to AAN interests or activities. Dr. Weathers has a non-compensated relationship as a Member of the Registry Subcommittee with American Academy of Neurology that is relevant to AAN interests or activities. Dr. Weathers has a non-compensated relationship as a Member of the NCP Editorial Board with American Academy of Neurology that is relevant to AAN interests or activities.
Daniel Ontaneda, MD, PhD, FAAN (Cleveland Clinic)	Dr. Ontaneda has received personal compensation in the range of $500-$4,999 for serving as a Consultant for Novartis. Dr. Ontaneda has received personal compensation in the range of $500-$4,999 for serving as a Consultant for Genentech/Roche. Dr. Ontaneda has received personal compensation in the range of $500-$4,999 for serving as a Consultant for Biogen Idec. Dr. Ontaneda has received personal compensation in the range of $500-$4,999 for serving on a Scientific Advisory or Data Safety Monitoring board for Genentech/Roche. The institution of Dr. Ontaneda has received research support from NIH. The institution of Dr. Ontaneda has received research support from PCORI. The institution of Dr. Ontaneda has received research support from NMSS. The institution of Dr. Ontaneda has received research support from Genetech.