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Patient Factors Associated With Use of Adult Primary Care and Virtual Visits During the COVID-19 Pandemic.
Ritzwoller, Debra P; Goodrich, Glenn W; Tavel, Heather M; Odelberg, Michelle R; Davis, Teaniese L; Gander, Jennifer C; McCracken, Courtney E; Weinfield, Nancy S; Roblin, Douglas W.
Afiliação
  • Ritzwoller DP; Institute for Health Research, Kaiser Permanente Colorado, Aurora, CO.
  • Goodrich GW; Institute for Health Research, Kaiser Permanente Colorado, Aurora, CO.
  • Tavel HM; Institute for Health Research, Kaiser Permanente Colorado, Aurora, CO.
  • Odelberg MR; Institute for Health Research, Kaiser Permanente Colorado, Aurora, CO.
  • Davis TL; Center for Research and Evaluation, Kaiser Permanente Georgia, Atlanta, GA.
  • Gander JC; Center for Research and Evaluation, Kaiser Permanente Georgia, Atlanta, GA.
  • McCracken CE; Center for Research and Evaluation, Kaiser Permanente Georgia, Atlanta, GA.
  • Weinfield NS; Kaiser Permanente Mid-Atlantic Permanente Research Institute, Rockville, MD.
  • Roblin DW; Kaiser Permanente Mid-Atlantic Permanente Research Institute, Rockville, MD.
Med Care ; 61(Suppl 1): S12-S20, 2023 04 01.
Article em En | MEDLINE | ID: mdl-36893414
BACKGROUND: The delivery of adult primary care (APC) shifted from predominately in-person to modes of virtual care during the COVID-19 pandemic. It is unclear how these shifts impacted the likelihood of APC use during the pandemic, or how patient characteristics may be associated with the use of virtual care. METHODS: A retrospective cohort study using person-month level datasets from 3 geographically disparate integrated health care systems was conducted for the observation period of January 1, 2020, through June 30, 2021. We estimated a 2-stage model, first adjusting for patient-level sociodemographic, clinical, and cost-sharing factors, using generalized estimating equations with a logit distribution, along with a second-stage multinomial generalized estimating equations model that included an inverse propensity score treatment weight to adjust for the likelihood of APC use. Factors associated with APC use and virtual care use were separately assessed for the 3 sites. RESULTS: Included in the first-stage models were datasets with total person-months of 7,055,549, 11,014,430, and 4,176,934, respectively. Older age, female sex, greater comorbidity, and Black race and Hispanic ethnicity were associated with higher likelihood of any APC use in any month; measures of greater patient cost-sharing were associated with a lower likelihood. Conditional on APC use, older age, and adults identifying as Black, Asian, or Hispanic were less likely to use virtual care. CONCLUSIONS: As the transition in health care continues to evolve, our findings suggest that to ensure vulnerable patient groups receive high quality health care, outreach interventions to reduce barriers to virtual care use may be warranted.
Assuntos

Texto completo: 1 Coleções: 01-internacional Base de dados: MEDLINE Assunto principal: Telemedicina / Atenção à Saúde / COVID-19 Tipo de estudo: Observational_studies / Prognostic_studies / Risk_factors_studies Aspecto: Determinantes_sociais_saude Limite: Adult / Humans Idioma: En Revista: Med Care Ano de publicação: 2023 Tipo de documento: Article País de publicação: Estados Unidos

Texto completo: 1 Coleções: 01-internacional Base de dados: MEDLINE Assunto principal: Telemedicina / Atenção à Saúde / COVID-19 Tipo de estudo: Observational_studies / Prognostic_studies / Risk_factors_studies Aspecto: Determinantes_sociais_saude Limite: Adult / Humans Idioma: En Revista: Med Care Ano de publicação: 2023 Tipo de documento: Article País de publicação: Estados Unidos