296 - Disparities in Virtual Visit Utilization in Primary Care during the COVID-19 Pandemic

Poster Number: 296
Publication Number: 296.347

Morgan Walls, Atrium Health, Charlotte, NC, United States; Kelly Reeves, Atrium Health, Charlotte, NC, United States; Tsai-Ling Liu, Atrium Health, Charlotte, NC, United States; Jamari L. Tyson, Atrium Health, Charlotte, NC, United States; Melinda Manning, Atrium Health, Charlotte, NC, United States; Katherine O'Hare, Atrium Health, Charlotte, NC, United States; Brian Lurie, Levine Children's Hospital, Charlotte, NC, United States

Background: Implementation of virtual visits in pediatric primary care rapidly expanded with the onset of the COVID-19 pandemic. It is important to examine differences in virtual visits by patient characteristics to identify and address potential disparities in its utilization.

Objective: To examine the association between patient characteristics, and 1) in-person visits vs. virtual visits, and 2) phone vs. video visits, within an integrated primary care network during the pandemic

Design/Methods: This retrospective study included 452,124 clinic encounters of 123,692 children aged 0-17 who had a visit at a pediatric or family medicine primary care practice within an integrated network in NC and SC between 3/1/20-12/31/20. Patient characteristics included age, sex, race/ethnicity, language, insurance and Area Deprivation Index (ADI, based on patient address). Outcomes of interest included: 1) In-clinic vs. Virtual Visit (phone or video technology) and 2) phone vs. video visit, among patients who had a virtual visit. Multilevel logistic regression modeling was used to examine the relationship between patient characteristics and outcomes of interest.

Results: Out of 452,124 visits, 90% (407,933) were in-office visits, while 10% (44,191) were virtual visits. Patients were more likely to have a virtual visit vs. an in-person visit if they were older than age 2 years. Compared to White patients, patients who identified as Non-Hispanic Black (Odds Ratio, OR: 0.92 [0.88-0.96]) or Hispanic (OR: 0.93 [0.87-0.99]) were less likely to have a virtual visit. Patients who spoke Spanish had lower odds of having a virtual visit compared to English-speaking patients (OR: 0.72 [0.66-0.78]). Patients living in a neighborhood with higher social deprivation were less likely to have a virtual visit compared to those living in the least socially deprived neighborhood (ADI quintile 1 vs ADI quintile 5, OR: 0.78 [073-0.83]). Of patients who had a virtual visit, there was no significant difference in phone vs. video visit by age, race/ethnicity, insurance, or ADI. Spanish-speaking patients had lower odds of having a video visit compared to English-speaking patients (OR: 0.00 [0.00-0.03]).Conclusion(s): Racial/ethnic minority patients, Spanish-speaking patients and those living in a more socially deprived neighborhood were less likely to have virtual visits compared to in-person visits. Among virtual visit patients, Spanish-speaking patients were also less likely to have a video visit compared to a phone visit. These findings highlight the need to further explore and address barriers to virtual visits to mitigate disparities in care.