• Loretta Hsueh, Jie Huang, Andrea K Millman, Anjali Gopalan, Rahul K Parikh, Silvia Teran, and Mary E Reed.
• Kaiser Permanente Northern California Division of Research, 2000 Broadway, Oakland, CA, 94612, USA. lhsueh@uic.edu.
• J Gen Intern Med. 2023 Feb 1; 38 (3): 633640633-640.

BackgroundTelemedicine's dramatic increase during the COVID-19 pandemic elevates the importance of addressing patient-care gaps in telemedicine, especially for patients with limited English proficiency.ObjectiveTo examine the associations of patient language and patient-provider language concordance with telemedicine visit type (video versus telephone visit).DesignCross-sectional automated data study of patient-scheduled primary care telemedicine appointments from March 16, 2020, to October 31, 2020.SettingNorthern California integrated healthcare delivery system.ParticipantsAll 22,427 completed primary care telemedicine visits scheduled by 13,764 patients with limited English proficiency via the patient portal.MeasurementsCross-sectional association of electronic health record-documented patient language (Spanish as referent) and patient-provider language concordance with patients' choice of a video (versus telephone) visit, accounting for patient sociodemographics, technology access, and technology familiarity factors.ResultsOf all patient-scheduled visits, 34.5% (n = 7747) were video visits. The top three patient languages were Spanish (42.4%), Cantonese (16.9%), and Mandarin (10.3%). Adjusting for sociodemographic and technology access and familiarity factors and compared to patients speaking Spanish, video visit use was higher among patients speaking Cantonese (OR = 1.34, 95% CI: 1.18-1.52), Mandarin (OR = 1.33, 95% CI: 1.16-1.52), or Vietnamese (OR = 1.27, 95% CI: 1.09-1.47), but lower among patients speaking Punjabi (OR = 0.75, 95% CI: 0.75, 0.62-0.91). Language concordance was associated with lower video visit use (OR = 0.86, 95% CI: 0.80-0.93) and moderated associations of speaking Spanish, Cantonese, and Korean with video visit use. In addition, for all language groups, those with prior video visit use were more likely to re-use video visits compared to those with no prior use (p < .05 for all languages except Hindi with p = 0.06).ConclusionsAmong linguistically diverse patients with limited English proficiency, video telemedicine use differed by specific language. Disaggregating patient subpopulation data is necessary for identifying those at greatest risk of being negatively impacted by the digital divide.© 2022. The Author(s), under exclusive licence to Society of General Internal Medicine.

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