Telemedicine in the Wake of the COVID-19 Pandemic

Increasing Access to Surgical Care

Paige K. Dekker, BA; Priya Bhardwaj, MS; Tanvee Singh, MPH; Jenna C. Bekeny, BA; Kevin G. Kim, BS; John S. Steinberg, DPM; Karen K. Evans, MD; David H. Song, MD, MBA; Christopher E. Attinger, MD; Kenneth L. Fan, MD


Plast Reconstr Surg Glob Open. 2021;9(1):e3228 

In This Article


Table 1 describes the characteristics of the study cohort. During the study period, there were 506 patients seen before the lockdown and 278 patients were seen after, which amounts to a 45% decline in overall visits. Before the lockdown, the composition of our patient population was overrepresented by the elderly and Medicare (42.69% versus 8%) and underrepresented by Medicaid (15.02% versus 28%) when compared with the DC area population.[23] Moreover, the average median income is higher for the study group compared with that in the DC area ($99,002 versus $82,372). However, racial composition is similar. The majority of the cohort have active wounds. There is no difference in the SVI or median income by ZCTA before and after COVID-19. Video and phone visits went from comprising 0.59% and 0.79% of visits, respectively, to representing 26.26 and 18.35% of visits, whereas outpatient visits declined 43.2% (P < 0.001). New patient visits declined from 23.52% to 9.35% (P < 0.001). There was a decrease in patients seen without a history of surgery from 48.81% to 31.65% (P < 0.001). There were no significant changes in the number of no-show appointments.

Table 2 and Table 3 demonstrate characteristics of patients who showed or missed their appointment before and after the lockdown, respectively. Before the lockdown, younger (P = 0.006), male (P = 0.032), and established (P = 0.035) patients with Medicaid (P = 0.027) were more likely to have a no-show appointment. Patients with a higher SVI were also more likely to have a no-show appointment (0.49 versus 0.39, P = 0.007). After the lockdown, neither age, nor sex, nor established status, nor insurance, nor SVI were any longer significant.

Table 4 examines the SVI characteristics by visit type. Before the lockdown, the SVI of patients with a no-show in-person appointment was 0.50 compared with 0.39 (P = 0.007) for patients who showed for their in-person appointments. There was no difference in SVI after the lockdown between patients who had shown for their appointment and those who did not. Figure 1 demonstrates that the SVI of new patients (0.44 versus 0.45) and established patients (0.39 versus 0.41) increased after the lockdown versus before the lockdown, although this association was not statistically significant (P = 0.382).

Figure 1.

Mean SVI for new and established patients, before and after COVID-19 lockdown.

Table 5 reports the findings of the 2 multivariate regression models for no-show appointments before and after lockdown. Before lockdown, every year decrease in age resulted in a 2% increased chance in missing their appointment (OR = 0.98, P = 0.01). Similarly, male patients had a 1.94 increased odds of missing their appointment (P = 0.02). For socially vulnerable patients, every 0.1 increase in SVI results in 1.32 greater odds of loss to follow-up (P = 0.045). These associations no longer held true after the lockdown. In-person appointments were 3.72 times more likely to be a no-show compared with phone appointments (P = 0.039). There was no clustering of no-show appointments before (P = 0.335), after (P = 0.458), or amongst all patients (P = 0.387).