Assessing the Equity of Reach: Virtual Medical Visits Among Asthma Patients During the COVID-19 Pandemic

JO ANN SHOUP, PhD
Kaiser Permanente Colorado

The COVID-19 pandemic has affected routine asthma care, requiring rapid adaptation from in-person to virtual healthcare. Deleterious outcomes (e.g. hospitalization, death) may have been associated with not receiving early treatment for asthma exacerbations. Additionally, existing health disparities may have created an even wider chasm of care for under-represented racial and minority groups. Telehealth may help to bridge this gap, but the extent of the transition to virtual care among asthma patients, and across race and ethnicity, is unknown. We used the RE-AIM framework to examine the equitable reach and representativeness of virtual asthma visits among patients in an integrated healthcare system during the pandemic.

Patients diagnosed with persistent asthma within a single-site integrated healthcare setting which had existing infrastructure for virtual care (email, telephone, video visit, or chat-with-the-doc) prior to the pandemic.

Using International Classification Diagnostic (ICD-10) codes, we identified members with persistent asthma. Covariates included self-reported race, ethnicity, age, sex, and healthcare utilization prior to COVID-19. We determined income and education using census tract geo-coding. We categorized ethnicity as Latinx, and race as Asian, Black/African American, White, Other (Alaskan Native/American Indian or Native Hawaiian/Other Pacific Islander) and Unknown. To assess the association between race or ethnicity and use of virtual visits for asthma care, we used logistic regression and adjusted the model using covariates. We defined the dependent variable, visit type, as in-person only versus virtual visits for those who had one or more visits within the health system or any hospital.

Of 5796 asthma patients, 60.6% used virtual care March through October 2020. Race or ethnicity were not significantly associated with higher or lower use of virtual care visits during the pandemic: Latinx versus White (adjusted odds ratio [aOR]=1.02,95% confidence interval [CI]=0.87-1.18); Asian versus White (aOR=0.98,95% CI=0.66-1.45); Black versus White (aOR=1.16,95% CI=0.92-1.46); Other versus White (aOR=0.89,95% CI=0.69-1.15); Unknown versus White (aOR=0.85,95%CI=0.61-1.18).

RE-AIM’s dimension of reach guided measures of equitable healthcare access during a time of rapid adaptation of asthma care delivery due to the pandemic. Within an integrated health care system with existing virtual visit options and whose members had health insurance, use of virtual asthma care visits did not differ by race or ethnicity. It remains imperative to assess virtual healthcare access and use across multiple health conditions, across organizations without existing capacity for virtual medical care and in those with access barriers.