Abstract
INTRODUCTION: For the first time, our study tracked disparities in the utilization of audio-video and audio-only telehealth for outpatient visits before and during the COVID-19 pandemic. METHODS: Using a dataset of de-identified claims corresponding to telehealth and in-person visits, a retrospective cohort study was conducted for all beneficiaries continuously enrolled in Arizona Medicaid between October 2019 and November 2020. Our definition of telehealth only covered outpatient services delivered remotely via the audio-video or audio-only modality. Outcomes of interest were indicators of telehealth (vs. in-person) service delivery and audio-video (vs. audio-only) delivery of a telehealth service. Multivariate models evaluated the association between each outcome and demographic factors, including age, urban/rural location, sex, and race/ethnicity. RESULTS: In this cohort study of 1,799,537 beneficiaries, age over 75, male sex, Asian race, Black race, Hispanic ethnicity, and Native American race were associated with reduced odds of telehealth use for outpatient visits pre-pandemic. These deficits persisted for all groups except the Black race after the pandemic's onset. Throughout the study period, older age and Native American race were correlated with greater audio-video use while Black race indicated reduced odds of audio-video use. Hispanic ethnicity indicated lower odds of audio-video use only during the pandemic. Rural members exhibited greater odds of both overall telehealth and audio-video use for outpatient visits prior to the pandemic but both trends reversed as a rural-urban divide emerged during the pandemic. Spearman correlations between broadband access and audio-video uptake yielded no significant results pre-pandemic but a strong correlation emerged during the pandemic. DISCUSSION: Pandemic-era telehealth expansions reduced but did not eliminate pre-existing disparities in telehealth and audio-video utilization for outpatient visits, indicating a need for health systems to better engage minority, elderly, and rural populations and continue to support audio-only telehealth.