Overview: This study examined the relationship between changes in modalities of communication with healthcare providers and delayed care during the COVID-19 pandemic. Four type of communication modalities were examined, including in-person, phone, email and video. This study also identified the socio-demographic and health correlates of delayed care.Proposal text: The modalities of communication with healthcare providers have undergone substantial changes since the outbreak of COVID-19. Due to the healthcare workforce shortage and mandated social distancing to prevent the spread of the virus, in-person healthcare appointments are limited. Older adults are most likely to have chronic conditions and need routine health care services. However, a national poll shows that about one-third of US older adults have delayed their health care due to COVID-related concerns. Changes in the modalities of communication with healthcare providers may have led to delayed care among older adults. Focusing on older adults during the COVID outbreak, the present study aims to examine: 1) How changes in four modalities of communication with healthcare providers (in-person visit, phone, email, and video) are associated with delayed care? and 2) What are the socio-demographic correlates of delayed care?
Data came from the National Health and Aging Trend Study, a nationally representative survey study among the US Medicare beneficiaries 70 and older. Respondents were asked to indicate whether they communicated with their usual healthcare providers via in-person visit, by phone, by email and by video (telehealth) before and during the pandemic. A single-item question was used to ask the respondents whether they delayed planned or necessary care during the pandemic. Changes in the modalities of communication with healthcare providers were computed and coded into three categories: 1) no change before and during the pandemic, 2) changed from using this means of communication before the pandemic to non-use during the pandemic; and 3) changed from non-use of the communication means before the pandemic to use during the pandemic. Four logistic regressions were conducted to examine the effects of changes in communication means with healthcare providers and delayed care. Socio-demographic and health covariates were controlled in the analysis. Survey weights and design factors were incorporated to generate a national estimate.
Findings show that 28.92% of respondents who had in-person communication with healthcare providers before the outbreak did not have in-person communication during the outbreak. However, 16.86% of the respondents who did not use video to communicate with healthcare providers before the pandemic used this means during the pandemic. Results from the logistic regressions showed that older adults who changed from in-person communication before the pandemic to no in-person communication during the pandemic were significantly more likely to delay healthcare. Older adults who began using the phone during the pandemic to communicate with their healthcare provider were more likely to report putting off needed or planned care. Additionally, respondents who are women, have higher-level education and income, and are more depressed were more likely to delay care.
In conclusion, the findings suggest that older adults who used in-person communication before the pandemic but did not use this means of communication during the pandemic may have delayed care, possibly due to the limited availability of medical appointments. Further, delayed care was observed among older adults who did not use phone communication before the pandemic but used this means of communication during the pandemic.
