Disparities In Telemedicine Use Among Stroke Survivors: The Experience Of Three Tertiary Stroke Centers

Introduction: In response to the COVID-19 pandemic, outpatient stroke care delivery was rapidly transformed to telemedicine (TM) care through video (VTM) and telephone (TPH) visits around the world. We sought to evaluate the sociodemographic differences in TM use among stroke survivors. Methods: We conducted a retrospective chart review of stroke survivors evaluated at three tertiary stroke center clinics in the early period of the pandemic, 3/16/2020 till 7/31/2020. We compared the use of TM by demographics. The association between the use of TM and race/ethnicity was measured using the relative risk (RR) from a modified Poisson regression model adjusting for age, sex, insurance status, stroke type, visit type, and site. Results: A total of 2,024 individuals were included from UTHealth (n=878), MedStar Georgetown (n=269), and Columbia (n=877). Median age was 64 [IQR 52-74] and 53% were female. About half the patients had private insurance, 36% had Medicare and 15% had Medicaid. Two-thirds of the visits were established patients. TM accounted for 90% and the use of TM over office visits was primarily associated with site, not patients’ characteristics. Among TM users, older age, non-White, and Medicaid were associated with lower VTM compared to TPH use. Black (aRR 0.90, 95% CI 0.85-0.95, p<0.001) and Hispanic patients (aRR 0.91, 95% CI 0.86 - 0.97, p=0.005) had 10% lower VTM use while Asian patients (aRR 0.98, 95% CI 0.90 - 1.06, p=0.56) had similar VTM use compared to White patients (Figure). Conclusions: In our diverse cohort, we found differences in TM visit type by race and insurance, with overall higher utilization among established patients. These findings suggest disparities in VTM access across different stroke populations. As VTM becomes an integral part of outpatient practice, steps to ensure equitable access are essential.