Access to Virtual Care: A New Social Determinant of Health

INTRODUCTION: The novel COVID-19 illness has changed the world as we know it. The public health measures to contain the highly contagious virus mostly included social distancing, wearing a mask and hand hygiene. Our conventional daily routines adapted to accommodate for the need of the hour including the health care sector, hospital systems transformed their approach to provide timely and easy access to care for patients. However, challenges to provide standard of care were anticipated as neither the hospitals nor the patients were prepared initially for this sudden transition. Virtual care has seen tremendous growth in the United States since the pandemic started in 2020, and unprecedented progress has been made in the last year to provide patients virtual care that is well incorporated with their goals, accessibility and at the same time provide quality of care. We hypothesize that geographical areas which are limited in social resources or have higher income equalities will have higher telephone virtual visit or in person visits as compared to video visits, suggesting either lack of infrastructure or digital literacy in those areas. Lack of video visits can be a barrier to standard of care particularly in behavioral health. METHODS: We propose a de-identified retrospective study to analyze the visit type at all behavioral health outpatient clinics from January 2020 to most recent data available. Temporal trend of visit types based on demographics, geographical location, diagnoses and sub classification of virtual visit into telephone or video visit will be analyzed. Study has been approved by institutional IRB and currently is in data analysis phase. Aim 1: To study the impact of pandemic on temporal trend of outpatient visit subtypes (in person vs virtual) in behavioral health department. Aim 2: To study the impact of pandemic on temporal trend of outpatient video visits vs telephone visits in behavioral health department. Aim 3: Analyze demographics, location and diagnoses that may be affecting the virtual visits during the pandemic. RESULTS: Currently the study is in data analysis phase and results will be availble in January 2022 CONCLUSIONS: This pandemic has highlighted the vulnerability of our communities and health care systems. Tan et al in their recent study showed that the income inequality within US counties was associated with more cases and deaths due to COVID-19 in the summer months of 2020.(3) Relationship between race, income inequality and social resources are complex and implicated in predicting negative outcomes regarding COVID-19. Nearly 20% of U.S. counties are disproportionately black, and they accounted for 52% of COVID-19 diagnoses and 58% of COVID-19 deaths nationally in 2020.(4) With most healthcare system planning to incorporate virtual care as a standard of care, it is imperative that social determinants of health will impact access to virtual care in the imminent future and affect long term health outcomes. Additionally, access to virtual care have a complex relationship model with existing determinants but can also provide an opportunity to improve overall health by identifying limitations, populations and geographical areas which need higher level of awareness such as digital literacy or even perhaps infrastructure support to improve access to care. THIS RESEARCH WAS FUNDED BY: None