Investigating Disparities in Telehealth Among CKD Patients in a US Integrated Healthcare System

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Background: Telehealth utilization, including the use of telephone appointments (TAV) and video appointment visits (VAV), are a valuable alternative to in-person visits and were a crucial form of health delivery during the COVID-19 national emergency. Among chronic kidney disease (CKD) patients within an integrated healthcare system, we evaluated the rate of successfully completed telehealth visits and assess differences in adoption using an equity lens. Methods: A retrospective cohort study was conducted among individuals (age≥18yrs) with CKD stage 3 and 4 receiving care at Kaiser Permanente Southern California (KPSC). We limited our sample to patients with at least one in-person visit within 12 months prior to Mar 1, 2020 and followed them for 1 year. A successfully completed telehealth visit was defined as a ≥20 min completed appointment via TAV/VAV. Poisson regression with robust variance error was conducted to estimate the rate ratio for a successful telehealth visit. Results: Of 161,088 patients, 74% (N=118,456) had ≥ 1 successfully completed telehealth visit, 34% of which were VAVs. Younger age, female gender, white race, and English as spoken language were associated with the successful completion of a telehealth visit. Senior persons (85+) were less likely to have a successfully TAV/VAV compared to young adults (18-34 yrs) (RR:0.82; 95% CI:0.79-0.86) (Figure). Those having a KPSC online account were more likely to have successful TAV/VAV (RR:1.11; 95% CI:1.10-1.12). Medicaid patients had more successful telehealth visits while patients living in neighborhoods with less internet access were marginally less likely to have successful TAV/VAV (p=0.05).Figure.: Rate Ratio of successful completion of telchealth among CKD patientsConclusions: We observed disparities in adoption of telehealth care among CKD patients within an integrated health system. Our findings suggest that further studies and management strategies are needed to facilitate and improve equitable patient-centered care. Funding: Private Foundation Support

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