{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,7,2]],"date-time":"2026-07-02T06:10:25Z","timestamp":1782972625091,"version":"3.54.5"},"reference-count":33,"publisher":"Georg Thieme Verlag KG","issue":"03","funder":[{"name":"NCI Cancer Center Support","award":["P30 CA014520"],"award-info":[{"award-number":["P30 CA014520"]}]},{"name":"NIH\/NCATS","award":["UL1TR000427"],"award-info":[{"award-number":["UL1TR000427"]}]},{"name":"NIH\/NIDCD","award":["T32 DC009401"],"award-info":[{"award-number":["T32 DC009401"]}]}],"content-domain":{"domain":[],"crossmark-restriction":false},"short-container-title":["Appl Clin Inform"],"published-print":{"date-parts":[[2021,5]]},"abstract":"<jats:title>Abstract<\/jats:title><jats:p>\n          Background\u2003The COVID-19 pandemic led to dramatic increases in telemedicine use to provide outpatient care without in-person contact risks. Telemedicine increases options for health care access, but a \u201cdigital divide\u201d of disparate access may prevent certain populations from realizing the benefits of telemedicine.<\/jats:p><jats:p>\n          Objectives\u2003The study aimed to understand telemedicine utilization patterns after a widespread deployment to identify potential disparities exacerbated by expanded telemedicine usage.<\/jats:p><jats:p>\n          Methods\u2003We performed a cross-sectional retrospective analysis of adults who scheduled outpatient visits between June 1, 2020 and August 31, 2020 at a single-integrated academic health system encompassing a broad range of subspecialties and a large geographic region in the Upper Midwest, during a period of time after the initial surge of COVID-19 when most standard clinical services had resumed. At the beginning of this study period, approximately 72% of provider visits were telemedicine visits. The primary study outcome was whether a patient had one or more video-based visits, compared with audio-only (telephone) visits or in-person visits only. The secondary outcome was whether a patient had any telemedicine visits (video-based or audio-only), compared with in-person visits only.<\/jats:p><jats:p>\n          Results\u2003A total of 197,076 individuals were eligible (average age\u2009=\u200946 years, 56% females). Increasing age, rural status, Asian or Black\/African American race, Hispanic ethnicity, and self-pay\/uninsured status were significantly negatively associated with having a video visit. Digital literacy, measured by patient portal activation status, was significantly positively associated with having a video visit, as were Medicaid or Medicare as payer and American Indian\/Alaskan Native race.<\/jats:p><jats:p>\n          Conclusion\u2003Our findings reinforce previous evidence that older age, rural status, lower socioeconomic status, Asian race, Black\/African American race, and Hispanic\/Latino ethnicity are associated with lower rates of video-based telemedicine use. Health systems and policies should seek to mitigate such barriers to telemedicine when possible, with efforts such as digital literacy outreach and equitable distribution of telemedicine infrastructure.<\/jats:p>","DOI":"10.1055\/s-0041-1730026","type":"journal-article","created":{"date-parts":[[2021,6,9]],"date-time":"2021-06-09T22:47:19Z","timestamp":1623278839000},"page":"445-458","source":"Crossref","is-referenced-by-count":141,"title":["Disparities in Telemedicine Access: A Cross-Sectional Study of a Newly Established Infrastructure during the COVID-19 Pandemic"],"prefix":"10.1055","volume":"12","author":[{"given":"Vivian","family":"Hsiao","sequence":"additional","affiliation":[{"name":"University of Wisconsin-Madison, School of Medicine and Public Health, Madison, Wisconsin, United States"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Thevaa","family":"Chandereng","sequence":"additional","affiliation":[{"name":"Columbia University, Department of Biostatistics, New York City, New York, United States"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Robin L.","family":"Lankton","sequence":"additional","affiliation":[{"name":"University of Wisconsin-Madison, School of Medicine and Public Health, Madison, Wisconsin, United States"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Jeffrey A.","family":"Huebner","sequence":"additional","affiliation":[{"name":"University of Wisconsin-Madison, School of Medicine and Public Health, Madison, Wisconsin, United States"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Jeffrey J.","family":"Baltus","sequence":"additional","affiliation":[{"name":"University of Wisconsin Hospitals and Clinics, Madison, Wisconsin, United States"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Grace E.","family":"Flood","sequence":"additional","affiliation":[{"name":"Columbia University, Department of Biostatistics, New York City, New York, United 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chronic disease management during the Covid-19 pandemic","author":"S Nouri","year":"2020","journal-title":"NEJM Catal"},{"issue":"06","key":"ref9","doi-asserted-by":"crossref","first-page":"611","DOI":"10.1016\/j.puhe.2015.04.001","article-title":"Exposing some important barriers to health care access in the rural USA","volume":"129","author":"N Douthit","year":"2015","journal-title":"Public Health"},{"key":"ref10","volume-title":"2016 Broadband Progress Report","author":"Federal Communications Commission","year":"2016"},{"issue":"11","key":"ref11","doi-asserted-by":"crossref","first-page":"1816","DOI":"10.1093\/jamia\/ocaa156","article-title":"Telehealth in response to the COVID-19 pandemic: implications for rural health disparities","volume":"27","author":"K A Hirko","year":"2020","journal-title":"J Am Med Inform Assoc"},{"issue":"26","key":"ref12","doi-asserted-by":"crossref","first-page":"2456","DOI":"10.1056\/NEJMp1802313","article-title":"Making neighborhood-disadvantage metrics 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