• Katherine Sanchez, Heather Kitzman, Mahbuba Khan, Briget da Graca, Jeffrey Zsohar, and Frank McStay.
• From the Baylor Scott & White Research Institute, Dallas, TX (KS, MK, BDG); UT Southwestern Medical Center, Peter O'Donnell Jr. School of Public Health, Dallas, TX (HK); Baylor Scott & White Community Care Clinics (JZ); Duke-Margolis Center for Health Policy, Duke University (FM). Katherine.Sanchez@bswhealth.org.
• J Am Board Fam Med. 2023 Oct 11; 36 (5): 746754746-754.

IntroductionEarly in the COVID-19 pandemic, primary care adopted telehealth rapidly to preserve access. Although policy flexibilities persist, but with in-person access restored, insight regarding long-term policy reform is needed for equitable access, especially for underserved, low income, and rural populations.MethodsWe used electronic health record data to compare primary care telehealth use in practices serving primarily commercially insured patients versus clinics serving low-income uninsured patients, in March-June 2020 ("early COVID") and March-June 2022 ("late COVID").ResultsPrimary care visit mode differed significantly (P < .0001) between settings in both periods. In early COVID, video visits were most used in the commercially insured practices (54.50%), followed by office visits (32.76%); in the low-income, uninsured clinics, phone visits were most used (56.67%), followed by office visits (23.55%). In late COVID, 81.05% of visits to commercially insured practices and 92.04% to uninsured clinics were in-office; continuing telehealth use was primarily video. Smaller but significant (P ≤ .0001) differences in telehealth use by race/ethnicity were also observed, with Black and/or Hispanic patients less likely than White patients to use telehealth during both periods, after adjustment for other characteristics.ConclusionsFindings demonstrate the importance of both phone and video visits in preserving primary care access early in the pandemic. Telehealth use declined in late COVID, but still accounted for ∼20% of primary care visits in the commercially insured setting and less than 10% of visits in the community care clinics. Differences in telehealth use were largely by setting, reflecting income/insurance status, indicating disparities needing to be addressed.© Copyright by the American Board of Family Medicine.

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