Despite the devastating impact that the COVID-19 pandemic has had on human lives, the technological and healthcare advancements that have arisen have been monumental. Due to quarantine and social distancing protocols, providers were faced with the difficult task of determining how to provide care for their patients, virus-related or not. In the midst of this struggle to provide care that has previously been so hands-on, telehealth practices emerged as a popular option. Telehealth includes various remote healthcare services such as remote primary care, mental health services, and nonclinical services, and it takes many forms. Patients can connect with healthcare professionals through synchronous services (e.g., a live video call), asynchronous services, and remote patient monitoring [2]. Although the benefits and possibilities for the future of telehealth sound limitless, they raise the question of whether everyone will have equal access to these possibilities. While telehealth has the ability to reduce health disparities and increase health equity in many ways, it brings with it a new set of challenges in terms of inequities in healthcare, especially as related to the digital divide.
Healthcare providers and patients alike agree that the pandemic has made telehealth a “ubiquitous and indispensable part of our healthcare system” [6]. Patients report higher levels of satisfaction with visits, increased convenience due to not having to miss work or pay for transportation, increased engagement with their doctors through the use of a patient portal, and more [6]. These improvements are monumental; for many people, compromising time and money by missing work, losing income, or paying for childcare out-of-pocket, is unfeasible. These changes are even more significant due to the disproportional negative impact of COVID-19 on racial and ethnic minorities, which is a result of pre-existing health and social inequities [1]. The advantages of telehealth are widespread, with several systematic reviews concluding that telehealth improves cost of care, utilization, and general health outcomes for a wide range of diseases including diabetes, obesity, asthma, heart failure, depression, and more. Even the rate of diagnostic accuracy between in-person and remote encounters is comparable [7]. One study conducted on Medicaid members in fourteen states found that the use of telehealth visits for mental health rose from single digits to constituting nearly half of all Medicaid mental health visits within a period of six months during the pandemic [5]. From this research, telehealth seems like a superior option to increase equitable access to healthcare.
However, with this reduction of barriers to healthcare access comes a new set of challenges in access to healthcare, including variations in ethnic and racial minorities, age groups, and digital literacy. There are several barriers to telehealth, including differences in broadband and smartphone access, comfort level with technology for patients and providers, and the cultural acceptance of telehealth visits. Additionally, there are certain situations where in-person visits are more effective, and individuals with disabilities may experience unique challenges that make telehealth ineffective [1]. One study found that digital barriers are far more common in populations that were disproportionately affected by COVID-19, including ethnic and racial minorities, individuals with low income and less education, non-native English speakers, older adults, and people living in rural areas. Researchers attributed this to disparities in access to care and the digital divide, as well as acknowledged that these are larger systemic effects present in healthcare as a whole. For example, elderly populations were associated with decreased telemedicine and video use and lower technology adoption. Furthermore, patients with median household incomes under $50,000 had significantly less telehealth visits than other populations, as did patients who were Black and Latinx. Similarly, women had less telehealth and video use (likely due to childcare burden) [4]. Hence, despite increasing access to care for several populations, telehealth can isolate other demographics, especially those who need the care most.
This issue necessitates the use of innovative interventions to reduce barriers of access to telehealth, including a focus on culturally competent care. Certain interventions have already proven successful; for example, the Federal Communications Commission Lifeline program provides a discount in broadband service to low income individuals [1]. Other interventions can focus on identifying access gaps in populations, assessing patient’s needs before telehealth visits (medical, cultural, linguistic, technological), focusing on provider training and patient advocacy, increasing connections to the local community, and more [3]. Overall, the growth of telehealth has several implications for health equity, and new interventions must be enacted to make it a successful method of reducing health disparities.
References
Centers for Disease Control and Prevention. (2020). Telehealth & Health Equity: Considerations for addressing health disparities during the COVID-19 pandemic. Centers for Disease Control and Prevention. Retrieved on March 5, 2022, from https://emergency.cdc.gov/coca/calls/2020/callinfo_091520.asp
The Future of Telehealth. (n.d.). Retrieved on March 5, 2022, from https://publichealth.tulane.edu/blog/future-of-telehealth/
Telehealth.HHS.gov. Health equity in Telehealth. (n.d.). Retrieved on March 5, 2022, from https://telehealth.hhs.gov/providers/health-equity-in-telehealth/
mHealthIntelligence. (2020). Telemedicine care disparities draw concern for health equity. mHealthIntelligence. Retrieved on March 5, 2022, from https://mhealthintelligence.com/news/telemedicine-care-disparities-draw-concern-for-health-equity
Minemyer, P. (2021). Anthem Study: Telehealth helped address pandemic health disparities, but gaps remain. Fierce Healthcare. Retrieved on March 5, 2022, from https://www.fiercehealthcare.com/tech/anthem-study-telehealth-helped-address-pandemic-health-disparities-but-gaps-remain
Shah, S. D., Alkureishi, L., & Lee, W. W. (2021). Seizing the moment for telehealth policy and equity: Health Affairs Forefront. Health Affairs. Retrieved on March 5, 2022, from https://www.healthaffairs.org/do/10.1377/forefront.20210909.961330/
Telediagnosis for acute care: Implications for the quality and safety of diagnosis. AHRQ. (n.d.). Retrieved on March 5, 2022, from https://www.ahrq.gov/patient-safety/reports/issue-briefs/teledx-2.html