Although the rapid rise of telemedicine has proven invaluable for much of the US population over the last year, this has not held true for everybody. As with traditional health care, social factors are still hindering telemedicine’s reach to some communities. Industry experts are warning that as telemedicine appointments become a permanent part of the “new normal” of health care delivery, proactive measures must be taken to ensure that patients are not continually stymied by social factors in trying to access health care via telemedicine.
A recent study examined nearly 150,000 patients who had pre-scheduled telemedicine appointments for primary care visits and specialty ambulatory clinics in a large academic health system from March 16, 2020 to May 11, 2020. Overall, the researchers found varying rates of usage among different demographics, similar to those of in-person visits. Among their findings:
- Out of almost 150,000 patients with scheduled telemedicine appointments, only 54.4% completed the telemedicine visit. Of these, 45.6% used video visits; the remaining 54.4% relied on telephone (audio-only) visits.
- Several characteristics were associated with a lower rate of completing a telemedicine appointment: age 55 or older, Asian race, having a preferred language that is not English, and Medicaid insurance.
- Other characteristics correlated with a lower rate of using video in the telemedicine appointment: age 55 or older, female gender, Black race, Latinx ethnicity, and lower household income.
Additional troubling factors, not examined here but demonstrated in other studies, include lack of access to good broadband service, lack of access to a camera capable of handling telemedicine appointments, and lack of technical ability to properly install, register, and run a telemedicine app/program.
Given this data, the authors concluded that inequities in care have indeed carried over from traditional medicine to telemedicine. They offer several speculations on which barriers are keeping which communities from better utilizing telemedicine appointments, such as a poorer patient-doctor relationship, previous frequent negative interactions with providers due to biases in care delivery, Blacks and Latinx patients being overrepresented in low-paying essential industries, and women handling an increased burden of childcare.
The key to eroding the disparities in telemedicine care, the researchers surmise, starts with intentional caring, such as educating health care providers and staff to interact with various social groups in a way that validates and respects them and their cultures. Clinicians need to understand their patients’ unique situations and get to know them personally; for example, a patient with limited funds might have to choose between food or medicine next month. Over time, both of these behaviors can lead to stronger doctor-patient relationships, more trust, and hence more acceptance of telemedicine appointments.
Another possibility, known as “care matching,” pairs patients with providers within the same/similar social group, such as Black patients working with Black providers. However, this approach fails to educate all providers, regardless of background, to be conscious of social factors; in this case, the issue of social disparities in telemedicine usage is likely to remain unchanged significantly.
Even beyond from the telemedicine appointment, providers can help patient groups increase their access to health care and to appropriate medical devices. Some health care systems have begun “prescribing” a “connected care kit,” which contains a broadband-capable device, broadband service, and home diagnostic devices such as a glucometer, blood pressure cuff, or accurate scale. By proffering connected care kits and training caregivers on their usage, providers can equip patients to overcome the major, traditional barriers to telemedicine.
In light of this data, telemedicine advocates seem to feel optimistic about reducing inequities in care. Well-planned, deliberate initiatives can help bring telemedicine to those who may need it most. Such measures can also help strengthen the bond between patient and provider, which encourages patients to be more communicative and forthcoming about their symptoms and situation. This additional information enables the provider to evaluate and diagnose the patient more accurately, as well as train the patient on the use of home diagnostic devices when appropriate. Altogether, with conscious effort, preplanned actions designed to reduce the inequities in telemedicine usage—regardless of cause—brings us one large step closer to the ultimate goal: healthier, more-informed patients and better outcomes.
For more information, visit these sites:
MHealth Intelligence: Telemedicine Care Disparities Draw Concern For Health Equity
JAMA: Patient Characteristics Associated With Telemedicine Access for Primary and Specialty Ambulatory Care During the COVID-19 Pandemic
US News: Some Americans Can’t Access Telemedicine, Study Shows
Telemedicine Poised to Address Social Factors Affecting Health