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Abstract
Background
Shelter‐in‐place orders during the COVID‐19 pandemic created unmet health‐related
and access‐related needs among older adults. We sought to understand the prevalence
of these needs among community‐dwelling older adults.
Methods
We performed a retrospective chart review of pandemic‐related outreach calls to older
adults between March and July 2020 at four urban, primary care clinics: a home‐based
practice, a safety net adult medicine clinic, an academic geriatrics practice, and
a safety net clinic for adults living with HIV. Participants included those 60 or
older at three sites, and those 65 or older with a chronic health condition at the
fourth. We describe unmet health‐related needs (the need for medication refills, medical
supplies, or food) and access‐related needs (ability to perform a telehealth visit,
need for a call back from the primary care provider). We performed bivariate and multivariate
analyses to examine the association between unmet needs and demographics, medical
conditions, and healthcare utilization.
Results
Sixty‐two percent of people had at least one unmet need. Twenty‐six percent had at
least one unmet health‐related need; 14.0% needed medication refills, 12.5% needed
medical supplies, and 3.0% had food insecurity. Among access‐related needs, 33% were
not ready for video visits, and 36.4% asked for a return call from their provider.
Prevalence of any unmet health‐related need was the highest among Asian versus White
(36.4% vs. 19.1%) and in the highest versus lowest poverty zip codes (30.8% vs. 18.2%).
Those with diabetes and COPD had higher unmet health‐related needs than those without,
and there was no change in healthcare utilization.
Conclusions
During COVID, we found that disruptions in access to services created unmet needs
among older adults, particularly for those who self‐identified as Asian. We must foreground
the needs of this older population group in the response to future public health crises.
Key Points Question What sociodemographic factors are associated with higher use of telemedicine and the use of video (vs telephone) for telemedicine visits for ambulatory care during the coronavirus disease 2019 (COVID-19) pandemic? Findings In this cohort study of 148 402 patients scheduled for primary care and medical specialty ambulatory telemedicine visits at a large academic health system during the early phase of the COVID-19 pandemic, older age, Asian race, non-English language as the patient’s preferred language, and Medicaid were independently associated with fewer completed telemedicine visits. Older age, female sex, Black race, Latinx ethnicity, and lower household income were associated with lower use of video for telemedicine care. Meaning This study identified racial/ethnic, sex, age, language, and socioeconomic differences in accessing telemedicine for primary care and specialty ambulatory care; if not addressed, these differences may compound existing inequities in care among vulnerable populations.
This article is being made freely available through PubMed Central as part of the
COVID-19 public health emergency response. It can be used for unrestricted research
re-use and analysis in any form or by any means with acknowledgement of the original
source, for the duration of the public health emergency.
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