Disparities in Access to Virtual Care for Urinary Tract Infections During the COVID-19 Era
Abstract
Objective To characterize the difference in uptake of virtual care for urinary tract infections (UTIs) by demographic
variables in the COVID-19 era.
Methods We conducted a retrospective review of outpatient encounters for UTIs across a large health care system.
The cohort was defined as patients with an encounter diagnosis of UTI via in-person or virtual care (telephone or
technology-supported care), between March 1, 2020, and February 28, 2021. Analysis was limited to the first UTI
encounter of the year for each patient. We compared the use of in-person and virtual visits by demographic variables
using chi-square tests and multivariate logistic regression.
Results A total of 6744 patients, with a mean age of 61 years, were seen for UTI during the study period. The
majority of patients were White (85.5%) and female (83.7%), and were seen in person (55.9%). Of those seen virtually,
52.0% participated in telephone-only visits, and 47.9% were seen via technology-supported care, using video or chatbased
platforms. On multivariate logistic regression, age under 30, lowest-quartile income, male sex, and a primary
language other than English increased the odds that patients had been seen in person. Among those seen virtually,
age over 50 significantly increased the odds of a telephone visit, as did being Black or Native American, having a
lower-quartile income, and speaking a non-English primary language.
Conclusions Although the expansion in virtual care has given some patients easier access to necessary care, the
“digital divide” has worsened existing disparities for certain vulnerable populations. We demonstrate a difference in
uptake of virtual health care by age, race, primary language, and income.
The Société International d'Urologie (SIU), which owns and publishes the Société International d'Urologie Journal (SIUJ), does not require authors of papers published in the journal to transfer copyright. Instead, we ask authors to grant an exclusive licence that allows us to publish the article in SIUJ (and any derivative or related products or publications) and that allows us to sub-license such rights and exploit all subsidiary rights.
Authors retain the right to use their own articles for their own non-commercial purposes without seeking explicit permission from SIU.
The SIUJ publication licence expressly defines “non-commercial” as “not primarily intended for or directed towards commercial advantage or monetary compensation.” Although no activity is completely disconnected from commercial activity, the following are generally considered to be non-commercial uses:
- Reproduction of a reasonable number (no more than 100) of print copies of the published paper for personal use (e.g., sharing with colleagues, including in grant applications).
- Posting a copy of the published version of the paper on the author’s own or their institution’s website. The article must be accompanied by this statement: ‘This article has been published in the SIUJ: [full citation; link]’.
- Inclusion of the paper in a course pack, with a maximum of 100 copies to be used in the author’s institution. The copies must include the following acknowledgement: ‘This article has been published in the SIUJ: [full citation; link].’
As the distinction between commercial and non-commercial is not always clear, authors are strongly advised to seek permission from SIU for any use that may be considered to have a commercial aspect.
We ask the corresponding author to read the terms of the licence and then to grant this exclusive licence on behalf of all authors by indicating agreement to the following statement:
The corresponding author has the right to grant on behalf of all authors and does grant on behalf of all authors, an exclusive licence on a worldwide basis to the SIU and its licensees to permit this article (if accepted) to be published in the SIUJ and any other SIU products and publications and to exploit all subsidiary rights, as set out in our licence agreement.
Review and Decision
Most submissions will be reviewed by a senior editor within 2 weeks. Many manuscripts will be rejected at this point for a variety of reasons, including subject matter outside the scope of the SIUJ, flawed design, discredited or outdated methodology, poor organization or presentation, failure to conform to ethical requirements, and apparent plagiarism.The remaining manuscripts will be sent for peer review. The SIUJ uses a single-blind process: reviewers know the identity of the authors, but the authors are not told who has reviewed their manuscript, and SIUJ ensures that potentially identifying information is removed from comments sent to them. Reviewers are asked to make their recommendations within 10 days, after which a senior/specialist editor will consider their comments and recommend provisional acceptance dependent on satisfactory revision, acceptance without revision, or rejection. Authors should receive a final decision within 4 to 6 weeks of submission.
