Accessibility of Telehealth Services During the COVID-19 Pandemic: A Cross-Sectional Survey of Medicare Beneficiaries

Prev Chronic Dis. 2021 Jul 1;18:E65. doi: 10.5888/pcd18.210056.

Abstract

Introduction: Telehealth plays a role in the continuum of care, especially for older adults during the COVID-19 pandemic. Our objective was to examine factors associated with the accessibility of telehealth services during the COVID-19 pandemic among older adults.

Methods: We analyzed the nationally representative Medicare Current Beneficiary Survey COVID-19 Rapid Response Supplement Questionnaire of beneficiaries aged 65 years or older. Two weighted multivariable logistic regression models were used to examine associations between usual providers who offered telehealth 1) during the COVID-19 pandemic and 2) to replace a regularly scheduled appointment. We examined factors including sociodemographic characteristics, comorbidities, and digital access and literacy.

Results: Of the beneficiaries (n = 6,172, weighted n = 32.4 million), 81.2% reported that their usual providers offered telehealth during the COVID-19 pandemic. Among those offered telehealth services, 56.8% reported that their usual providers offered telehealth to replace a regularly scheduled appointment. Disparities in accessibility of telehealth services by sex, residing area (metropolitan vs nonmetropolitan), income level, and US Census region were observed. Beneficiaries who reported having internet access (vs no access) (OR, 1.75, P < .001) and who reported ever having participated in video, voice, or conference calls over the internet before (vs not) (OR, 2.18, P < .001) were more likely to report having access to telehealth. Non-Hispanic Black beneficiaries (versus White) (OR, 1.57, P = .007) and beneficiaries with comorbidities (vs none) (eg, 2 or 3 comorbidities, OR, 1.25, 95% P = .044) were more likely to have their usual provider offer telehealth to replace a regularly scheduled appointment.

Conclusion: Although accessibility of telehealth has increased, inequities raise concern. Educational outreach and training, such as installing and launching an online web conferencing platform, should be considered for improving accessibility of telehealth to vulnerable populations beyond the COVID-19 pandemic.

MeSH terms

  • Aged
  • COVID-19* / epidemiology
  • COVID-19* / prevention & control
  • Comorbidity
  • Cross-Sectional Studies
  • Demography
  • Female
  • Health Services Accessibility* / standards
  • Health Services Accessibility* / statistics & numerical data
  • Healthcare Disparities* / ethnology
  • Healthcare Disparities* / organization & administration
  • Humans
  • Infection Control / methods*
  • Internet Access / statistics & numerical data
  • Male
  • Medicare / statistics & numerical data*
  • Needs Assessment
  • SARS-CoV-2
  • Socioeconomic Factors
  • Telemedicine* / methods
  • Telemedicine* / organization & administration
  • Telemedicine* / statistics & numerical data
  • United States / epidemiology