A Bronx Tale: Disparities in Access to Neurologic Telemedicine During the COVID-19 Pandemic

Objective: To determine whether there is a disparity in access to telemedical care that may be a function of socioeconomic status, language, or other demographic factors during the peak of the COVID-19 pandemic at a highly impacted urban center (Montefiore Medical Center) in Bronx, NY.

Methods: We retrospectively investigated potential patient characteristics that might be associated with an increased likelihood of receiving a telephone visit as opposed to a televideo visit for patients followed in the pediatric neurology, adult epilepsy and general neurology practices at Montefiore Medical Center during the 30-day period starting April 2, 2020, at the peak of COVID-19 pandemic in New York.

Results: We found that patients who had telephone encounters, as opposed to televideo encounters, were overall older, less likely to have commercial insurance, and more likely to have Medicaid. Among pediatric patients, a preferred language other than English was also associated with a higher proportion of telephone encounters. New patients in both the adult and pediatric groups were more likely to have televideo visits.

Conclusions: Our findings identify demographic factors, including age, insurance type, and language preference, which may play a role in access to televideo encounters among neurology patients in an urban center during the COVID-19 pandemic. We suggest several potential practice, institution, and community-based interventions which might further expand access to televideo care for neurology patients.