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Age-related Disparity in Participation of Video-based Telehealth

Key findings

  • This retrospective study compared billing data on outpatient gastroenterology and hepatology encounters during 11 weeks of the first COVID-19 surge at Massachusetts General Hospital versus the same dates in 2019
  • The number of outpatient gastrointestinal encounters was 6,368 in the 2019 comparison period and 6,171 during the COVID-19 surge (97% of the previous year's volume)
  • During the COVID-19 surge, 51% of patients 60 years of age or old older and 35% of those < age 60 had telephone visits (P < 0.001)
  • For videoconferences, the respective figures were 44% and 59% (P < 0.001)
  • Solutions are urgently needed to address the age-related disparity in participation in video-based telehealth

Telehealth was rapidly implemented in response to COVID-19 and is expected to persist as a prevalent option for delivering medical care. To guide the future of telehealth in gastroenterology, researchers in the Division of Gastroenterology at Massachusetts General Hospital looked back at how telehealth was used in their clinic during the first surge of the pandemic.

The volume of outpatient visits was only slightly reduced, they found, but older adults were less likely than younger adults to have the video-based visits that allow a relatively complete examination. Bharati Kochar, MD, MSCR, gastroenterologist, Ryan Nipp MD, MPH, an oncologist at the Gastrointestinal & Geriatric Oncology in the Mass General Cancer Center, and Christine Seel Ritchie, MD, MSPH, director of research in the Division of Palliative Care and Geriatric Medicine and director of the Mongan Institute Center for Aging and Serious Illness at Mass General, and colleagues give the specifics in a letter to the editor of The American Journal of Gastroenterology.

Study Methods

The researchers retrospectively analyzed billing data on outpatient encounters during 11 weeks of the first COVID-19 surge at Mass General. For most patients, the primary diagnosis was a general gastrointestinal condition (57%), followed by liver disease (21%) and inflammatory bowel disease (19%). Those encounters were compared with encounters for the same dates in 2019.


The number of outpatient GI encounters:

  • 2019 comparison period: 6,368
  • COVID-19 surge in 2020: 6,171 (97% of the previous year's volume)—53% videoconferences, 41% telephone conferences, 6% in-person visits

The proportion of outpatients ≥60 years old:

  • 2019 comparison period: 41%
  • COVID-19 surge in 2020: 39% (P = NS)

The types of encounters during COVID-19:

  • Telephone visits: 51% of patients ≥60 and 35% of those <60 (P < 0.001)
  • Videoconferences: 44% of patients ≥60 and 59% of those <60 (P < 0.001)

Closing the Gap in Care

Solutions are urgently needed to address the age-related disparity in participation in video-based telehealth. Older adults are more likely than younger people to have complex medical conditions and atypical presentations that are difficult to assess by telephone.

A partial answer to ensure equity in telehealth access may be to invest in "technology navigators," who could assist older patients and others who have reduced digital literacy, lack consistent Internet access or have visual/hearing impairments.

Learn more about Geriatric Medicine at Mass General

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