Abstract 4139730: Impact of Telemedicine on Access to Care for New Patients at an Academic Cardiovascular Center: An Analysis of Distance and Time to Visit

Introduction: Telemedicine allows patients to attend visits from a distance and has been linked to reduced clinic wait times. However, little is known about its impact on catchment area and scheduling efficiency for new patients. We assessed the association of new patient visit (NPV) modality with patient–clinic distance and time to visit (wait time from day of scheduling to day of visit) across patient demographics and pandemic phases. Methods: We extracted visit data at an academic cardiovascular center in Northern California from Jan 2017 to Nov 2023. We used linear models with fixed effects for clinician and patient characteristics to assess the association of NPV modality with distance and time to visit. Results: There were 8,104 and 3,566 NPVs in the mid-pandemic (Jan 2021–Mar 2022) and post-pandemic (Apr 2023 onwards) periods respectively, conducted by 141 clinicians. The proportion of visits conducted by telemedicine decreased from 58% to 40% from the mid- to post-pandemic periods. During the mid-pandemic period, NPVs conducted by telemedicine were more likely to fall outside the center’s pre-pandemic catchment area (100-mile radius) with an adjusted odds ratio of 1.06 (95% CI 1.03, 1.09). This effect did not change significantly post-pandemic, nor did it vary by sex, race, ethnicity, or public insurance status in either period. Time to visit for telemedicine NPVs was 8 days shorter (95% CI 2, 14) during the mid-pandemic period, and 20 days shorter post-pandemic (95% CI 10, 29). During the post-pandemic period, those with Medicaid waited 28 fewer days (95% CI 16, 41) and those with Medicare waited 16 fewer days (95% CI 6, 25) when the modality was telemedicine, whereas those with private insurance saw a smaller reduction of 12 days (95% CI 3, 21). Conclusions: At this academic cardiovascular center, new patients seen via telemedicine were more likely to reside outside the center’s traditional catchment area and had shorter times to new cardiology visits. These effects persisted throughout and beyond the pandemic. Strategic implementation of telemedicine may allow cardiovascular practices to broaden their reach to new patients.