By Kat Jercich
A wide-ranging study published this past week in the Journal of the American Medical Association found that older people, women, Black and Latinx individuals, and patients with lower household incomes were less likely to use video for telemedicine care during the early phase of the COVID-19 pandemic.
The cohort study, which researchers called “the first large-scale study to characterize inequitable access to telemedical care,” relied on data from nearly 150,000 unique patients who scheduled telemedicine visits from March 16 to May 11, 2020. It found that older patients, Asian people, and non-English-speaking individuals had lower rates of completed telemedicine visits.
“Telemedicine has the potential to be leveraged to increase access to care among patient groups that may have traditionally faced barriers to in-person care,” wrote researchers. “However, we must be intentional with implementation to ensure that all patients are equipped to effectively participate in telemedicine care.”
WHY IT MATTERS
The research team from the University of Pennsylvania health system sought to compare the demographic characteristics of patients who completed a telemedicine encounter (either via phone or video) with those who were scheduled for one, but did not complete it.
Using the electronic health record, the team extracted demographic information for adult patients scheduled at UPenn’s health system’s primary care and medical specialty clinics for telemedicine care in the first few months of the pandemic.
A total of 148,402 patients were scheduled during the study period. Of those, 80,780 (54.4%) completed a telemedicine encounter and 67,622 had a canceled or no-show visit.
Slightly less than half of the patients who showed up to their telemedicine encounters used video for their visits, and about 54% used telephone for their appointments.
Although patients with completed telemedicine visits were more likely to be female, women had lower rates of using telemedicine for specialty care and of using video for virtual calls overall.
Researchers noted that this may have been due to women bearing a disproportionate burden of childcare during the pandemic, perhaps limiting their time to engage with specialty virtual care.
Younger patients, those with commercial insurance, English-speaking patients and non-Asian patients were more likely to complete their visits, while patients who used video were more likely to be younger, white, and to have a higher median household income. Researchers noted that these numbers reflect existing medical inequities and could exacerbate them.
“The COVID-19 pandemic has devastated communities of color and marginalized populations, exposing the deep inequities of our U.S. healthcare system,” they wrote. “The findings of this study demonstrate that significant inequities are also present among patients in accessing necessary telemedicine care.”
THE LARGER TREND
Like other digital tools, telemedicine offers not just opportunities to address the digital divide, but also the potential to widen it. Some studies have suggested, for example, that Black and Latino patients in New York City were less likely to use telehealth during the pandemic, while others have said Black people were more likely to use virtual care.
Regardless, lawmakers and advocates say it’s vital to work toward expanding access to virtual care.
Rep. Anna Eshoo, D-Calif., who chairs the House Energy and Commerce Subcommittee on Health, said this past October that “obviously we need the expansion of broadband” to make that access happen.
But it will take coverage parity too, she added. On the Medicare side, she said, “We have to ensure that when we make [telehealth] permanent that … cutting-edge technologies are part of the reimbursement. Otherwise telehealth won’t work.”
ON THE RECORD
“As we develop and refine our telemedicine practice, we must intentionally design our system to mitigate inequity. Engagement with community members from vulnerable populations to design and tailor connected health technologies is essential to ensure accessibility for all patients,” wrote the UPenn researchers in the JAMA study.
“Although many have anxiously awaited a return to ‘normal,’ we must acknowledge that our previous ‘normal’ was a U.S. healthcare system and digital connectivity landscape fraught with inequity. As we build our telemedical health system, which is likely here to stay, a new ‘normal’ must prioritize the needs of those who have been historically marginalized to ensure that health equity is achieved,” they added.
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