Bridging the Divide: Unintended Consequences of the Shift to Home-Based Telemedicine

Objective To evaluate the impact on health care access of the change in telemedicine delivery from a clinic -based model, in which patients connect with their healthcare provider from local telemedicine clinics, to a home -based model, in which patients independently connect from their homes. Study design In this retrospective analysis, we compared relative uptake in telemedicine services in Period 1 (01/ 01/2019 to 03/15/2020, prepandemic, clinic -based model) vs Period 2 (03/16/2020 to 06/30/2022, home -based model) within a tertiary pediatric hospital system. Using multivariable logistic regression, we investigated the influence of telemedicine delivery model on patient sociodemographic characteristics of completed telemedicine visits. Results We analyzed 400 539 patients with 1 406 961 completed outpatient encounters (52% White, 35% Black), of which 62920 (4.5%) were telemedicine. In the clinic -based model (Period 1), underserved populations had greater likelihoods of accessing telemedicine: Hispanic ethnicity (OR = 1.41, P = .028) vs reference group nonHispanic, Medicaid (OR = 2.62, P < .001) vs private insurance, and low-income neighborhood (OR = 3.40, P < .001) vs medium -income. In aggregate, telemedicine utilization rapidly increased from Period 1 (1.5 encounters/day) to Period 2 (107.9 encounters/day). However, underserved populations saw less relative increase (Medicaid [OR = 0.28, P < .001], Hispanic [OR = 0.53, P < .001], low-income [OR = 0.23, P < .001]). Conclusions We observe that the clinic -based model offers more equitable access, while the home -based model offers more absolute access, suggesting that a hybrid model that offers both home -based and clinic -based services may result in more absolute and equitable access to telemedicine. (J Pediatr 2024;269:113719).