Trends and Disparities in Hepatology Televisits at a Large Tertiary Care Center

Introduction: Telephone and video clinic visits (“televisits”) have the potential to improve access to hepatology care, though disparities in telehealth use across race/ethnicity, age, and socioeconomic status were revealed in studies from the early months of the COVID-19 pandemic. The aim of this study was to evaluate if these disparities persisted. Methods: We retrospectively assessed all in-person, video, and phone encounters in hepatology clinics at our institution between January 1, 2021 and December 31, 2022. Home addresses were geocoded for small-area estimates of internet access and socioeconomic disadvantage (Area Deprivation Index, ADI). Logistic regression models were performed to examine associations between sociodemographic factors and telehealth use. Results: Televisits represented 10.8% of hepatology encounters (2489/23137): 10.5% (2422) video, 0.1% (30) scheduled as phone, and 0.2% (37) converted from video to phone (Table 1). Televisit rates fell from 16.1% in January-June 2021 to 7.4% in July-December 2022 (ptrend < 0.001). Among 9925 unique patients, 18.6% completed ≥ 1 televisit; 3.5% completed multiple televisits. In regression models, factors associated with any telehealth use were female sex (OR 1.23, 95% CI 1.11 - 1.37), active email address (OR 5.71, 3.19 - 10.20), and distance from patient home to our institution (> 75 mi. vs. < 10 mi.: OR 1.97, 1.68 - 2.31). Factors associated with no televisits (exclusively in-person visits) included older age (> 65 y. vs. 18 - 40 y.: OR 0.48, 0.39 - 0.59), higher ADI (quintile 5 vs. 1: OR 0.73, 0.60 - 0.88), and preference for non-English language (OR 0.35, 0.22 - 0.54) (Image 1). Differences in telehealth use among Black, Asian, and White patients and by insurance type were not significant in adjusted models. Televisit completion by phone rather than video was associated with older age, higher ADI, lack of email address, and lower community internet access, but not significantly associated with race, ethnicity, or distance from our center (Figure 1). Conclusion: Race- and insurance-based disparities in telehealth adoption among hepatology patients appear attenuated by access to technology (internet/email). Age-, sex-, and proximity-based differences in televisit use persist; further research is needed to understand these differences. Efforts to expand internet access, digital literacy, and interpreter services are steps toward equitable telehealth.Figure 1.: Patient and Community Characteristics Associated with Completion of One or More Telehealth Encounters in Multivariable Logistic Regression. Abbreviations: Area Deprivation Index (ADI), ranging from most deprived (quintile 5) to least deprived (quintile 1). Table 1. - Telehealth Use By Sociodemographic Characteristics Among 9925 Unique Patients Any Televisit (n=1847), % (n) Only In-Person Visits (n=8078), % (n) P-value Age Group, y. < 0.001 18-40 25.4 (391) 74.6 (1147) 40-50 20.7 (282) 79.3 (1083) 50-65 17.6 (654) 82.4 (3071) ≥65 15.8 (520) 84.2 (2777) Sex < 0.001 Male 17.0 (776) 83.0 (3786) Female 20.0 (1071) 80.0 (4292) Ethnicity1 < 0.07 Hispanic 15.4 (71) 84.6 (390) Non-Hispanic 18.8 (1694) 81.2 (7318) Race2 < 0.001 Black 15.3 (279) 84.7 (1543) White 19.5 (1349) 80.5 (5556) Asian 16.5 (89) 83.5 (450) Other 20.7 (82) 79.3 (314) Preferred Language < 0.001 English 19.1 (1820) 80.9 (7725) Non-English 7.1 (27) 92.9 (353) Insurance < 0.001 Commercial 20.3 (942) 79.7 (3698) Medicare 17.2 (707) 82.8 (3394) Medicaid 18.2 (124) 81.8 (558) Other 15.3 (36) 84.7 (199) Self-Pay 14.2 (38) 85.8 (229) E-mail Address < 0.001 Yes 19.3 (1834) 80.7 (7582) No 3.2 (13) 96.8 (396) Distance from Institution, mi.3 < 0.001 <10 15.2 (407) 84.8 (2276) 10-< 25 18.3 (404) 81.7 (1801) 25-< 75 16.7 (461) 83.3 (2297) ≥75 25.2 (568) 74.8 (1684) (1) Missing 452 patients (4.6%); (2) missing 263 patients (2.6%); (3) missing 27 patients (0.2%).