Date of Award

January 2021

Document Type

Open Access Thesis

Degree Name

Master of Public Health (MPH)


School of Public Health

First Advisor

Judith Lichtman


Intro: Telemedicine has offset disruptions to outpatient chronic disease care during the COVID-19 pandemic. Studies have shown decreased video telemedicine engagement among patients of Black race, Hispanic ethnicity, older age, and with public insurance. We assessed if similar patterns were seen among providers who predominantly adopted video telemedicine during the COVID-19 pandemic.

Methods: A single-center longitudinal study of cardiovascular patients from March 16-October 31, 2020 was performed to study trends in video visit volume, variation in provider use of video visits, and identify predictors of video (vs. phone) visits using descriptive statistics and multivariable logistic regression.

Results: A total of 18,950 patients were studied with 51% having at least 1 video visit. Video visit volume rapidly increased from March to June 2020, where it accounted for 42% of all patient encounters. Large variation in the use of video visits among providers was observed with mean (standard deviation) use of 44% (±29). Among patients of high-video-use providers, lower video use was observed among patients of Black race, Hispanic ethnicity, older age, and those with public insurance and an activated MyChart account in descriptive statistics and multivariable adjustment. After adjusting for patient characteristics, patients with a high-video-use provider were 9.35 (95% confidence interval, 8.43-10.39) times as likely to have a video visit compared to patients of low-video-use providers. Patients without an activated MyChart were 0.33 (95% CI, 0.31-0.36) times as likely to have a video visit. Only 47% of patients of Black race had an activated MyChart vs. 66% of White patients (P<.001).

Discussion: Video telemedicine care has rapidly expanded during the COVID-19 pandemic with growing engagement among providers. We find that even among providers with high video adoption, the digital access divide persisted. Ensuring equitable access of telemedicine technology is crucial to reducing disparities as virtual care becomes more commonly integrated into modern healthcare. Increasing the use of MyChart, a patient portal with video telemedicine capabilities, among low video groups may improve accessibility. Other systemic approaches will likely be needed to further improve telemedicine access and engagement.


This is an Open Access Thesis.

Open Access

This Article is Open Access