Abstract: PO0859
Telemedicine Heightens Healthcare Disparities in Nephrology Ambulatory Care After COVID-19
Session Information
- COVID-19: Clinical and Basic Science Characteristics
October 22, 2020 | Location: On-Demand
Abstract Time: 10:00 AM - 12:00 PM
Category: Coronavirus (COVID-19)
- 000 Coronavirus (COVID-19)
Authors
- Lima, Florence, University of Kentucky Medical Center, Lexington, Kentucky, United States
- Christian, Jay, University of Kentucky Medical Center, Lexington, Kentucky, United States
- Larkin, Clay, University of Kentucky Medical Center, Lexington, Kentucky, United States
- Ahmad, Yahya Rauf, University of Kentucky Medical Center, Lexington, Kentucky, United States
- Donaldson, Katherine Michele, University of Kentucky Medical Center, Lexington, Kentucky, United States
- Athukorala, Ashami, University of Kentucky Medical Center, Lexington, Kentucky, United States
- Kebede, Hana, University of Kentucky Medical Center, Lexington, Kentucky, United States
- Ginn, Madison, University of Kentucky Medical Center, Lexington, Kentucky, United States
- Rao, Madhumathi, University of Kentucky Medical Center, Lexington, Kentucky, United States
Background
The COVID-19 pandemic paused in- person clinic visits and introduced telehealth (TH) creating a paradigm shift in ambulatory practice. TH remains out of reach for many patients, highlighting healthcare (HC) disparities.
Methods
We studied Nephrology ambulatory clinic schedules during the transition to TH (April 1 to May 15 2020) at the University of Kentucky (UK), Lexington KY. We estimated the proportion of patients who could perform TH visits, trends over time, compared TH use in Nephrology vs other clinics (cardiology, pulmonology, Infectious disease, women’s health), evaluated causes for non-use, and studied the geographic variation of TH use/non-use across the regions served by the hospital.
Results
TH was successfully adopted by 43.5% of the clinic population, without significant change across weeks (wk) 1 to 5. Wk 6 increased when reimbursement was allowed for telephone visits (p<0.01) (Figure 1). The % of patients unable to do TH dipped from 72% in wk 1 and remained steady at ~56.5% thereafter. Lack of internet access and/or smart device was the most frequent reason. The Nephrology clinic trend did not differ from other clinics. By spatial analysis, TH non-use rates clustered in geographic areas of Eastern and Southern KY with the lowest socioeconomic indices (Figure 2).
Conclusion
The Nephrology clinic at UK, serves the Eastern half of KY, that includes poorer and largely rural regions. While TH provides a remarkably useful tool to reach patients, over 50% did not benefit, and use-rates reached saturation rapidly. TH further highlights HC disparities and the need to mitigate them.
Figure 1: TH trend by week
Figure 2: Distribution of TH non-use by zip-code