Disparities in telephone and video telehealth engagement during the COVID-19 pandemic

Jonathan W. Sachs, Peter Graven, Jeffrey A. Gold, Steven Z. Kassakian

Research output: Contribution to journalArticlepeer-review

41 Scopus citations


Objective: The COVID-19 pandemic and subsequent expansion of telehealth may be exacerbating inequities in ambulatory care access due to institutional and structural barriers. We conduct a repeat cross-sectional analysis of ambulatory patients to evaluate for demographic disparities in the utilization of telehealth modali-ties. Materials and Methods: The ambulatory patient population at Oregon Health & Science University (Portland, OR, USA) is examined from June 1 through September 30, in 2019 (reference period) and in 2020 (study period). We ?rst assess for changes in demographic representation and then evaluate for disparities in the utilization of telephone and video care modalities using logistic regression. Results: Between the 2019 and 2020 periods, patient video utilization increased from 0.2% to 31%, and tele-phone use increased from 2.5% to 25%. There was also a small but signi?cant decline in the representation males, Asians, Medicaid, Medicare, and non-English speaking patients. Amongst telehealth users, adjusted odds of video participation were signi?cantly lower for those who were Black, American Indian, male, prefer a non-English language, have Medicaid or Medicare, or older. Discussion: A large portion of ambulatory patients shifted to telehealth modalities during the pandemic. Seniors, non-English speakers, and Black patients were more reliant on telephone than video for care. The dif-ferences in telehealth adoption by vulnerable populations demonstrate the tendency toward disparities that can occur in the expansion of telehealth and suggest structural biases. Conclusion: Organizations should actively monitor the utilization of telehealth modalities and develop best-practice guidelines in order to mitigate the exacerbation of inequities.

Original languageEnglish (US)
Article numberooab056
JournalJAMIA Open
Issue number3
StatePublished - Jul 1 2021


  • Telemedicine
  • delivery of health care
  • healthcare disparities

ASJC Scopus subject areas

  • Health Informatics


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