28 Dec 2020

Disparities in Telehealth

With telehealth becoming an unprecedented portion of face-to-face healthcare visits because of the COVID-19 pandemic, the ability to monitor and combat telehealth disparities has become more important than ever [1]. Before the pandemic, telehealth primarily serviced the 81 million Americans living in Health Professional Shortage Areas, or HPSAs [2]. While the rise of telehealth has enabled healthcare practitioners to better bridge certain gaps, particularly by improving the quality and accessibility of telehealth services, research indicates that other gaps in healthcare equality have widened through the pandemic [2]. 

Researchers have identified various disparities in national telehealth usage [3]. An analysis of the 52,000 patients who were administered healthcare by New York’s Mount Sinai healthcare system from March to May 2020 demonstrated that Black and Latino patients are less likely than white or Asian patients to seek medical care via telehealth [1]. According to that same study, this is also true of patients for whom English is not their primary language and for older patients, with people 65+ especially unlikely to seek care through telehealth platforms [1, 3]. Additionally, obese patients and patients located in rural areas are more likely to use telehealth than their non-obese or urban/suburban counterparts [4]. 

The reasons for these disparities are widespread. For one, patients of color, lower socioeconomic status, and greater age are more likely to experience reduced digital literacy and a lack of telehealth awareness, due to decreased technological training [1]. Patients of all aforementioned groups may distrust digital healthcare because of several factors [1]. These include medical racism, limited access to physicians who speak their native language, a lack of confidence in technology, and restricted access to quality healthcare [1, 3]. Concerns about cost and coverage prominently affect patients in rural areas and those with lower socioeconomic statuses, further dissuading them from switching over to telehealth platforms [1]. Furthermore, broadband signal strength, healthcare self-efficacy, and access to technology can also explain why certain patients turn to telehealth at decreased rates [3]. 

Disparities may get worse as telehealth services become more market-driven and consumer-centered [5]. Sociologists indicate that these changes could further inequality by increasing mistrust and decreasing quality [5]. Predictive algorithms have historically been imperfect, discriminating against patients of color [5]. With the rise of telehealth, more processes will be computerized and fallible algorithms may be used, worsening preexisting disparities–unless healthcare providers move to counter discriminatory practices. 

To ensure that telehealth improves rather than worsens equity, several changes must occur. Telehealth technologies should take into account the needs of each community that will be serviced [2]. Health systems should work with local leaders to provide communities with the devices and courses needed to use telehealth effectively [2]. Hospitals and clinics should recruit diverse staff members and volunteers to increase trust in medical professionals and make healthcare safer for members of underrepresented groups [6]. Lastly, flexibility is essential: platforms must account for patients’ unique needs, past experiences, spoken languages, and digital literacy [6]. 

Because telehealth will likely endure past the COVID-19 pandemic, healthcare systems and providers have an absolute imperative to render these technologies accessible to all communities throughout the country.  

References 

[1] K. Jercich, “Study: NYC Black and Latino patients less likely than white patients to use telehealth during pandemic,” Healthcare IT News, Updated September 1, 2020. [Online]. Available: https://www.healthcareitnews.com/news/study-nyc-black-latino-patients-less-likely-white-patients-use-telehealth-during-pandemic

[2] M. Bean, “Telehealth expansion and health disparities: 3 leaders weigh in,” Becker’s Hospital Review, Updated November 3, 2020. [Online]. Available: https://www.beckershospitalreview.com/telehealth/telehealth-expansion-and-health-disparities-3-leaders-weigh-in.html

[3] S. Heath, “Are There Health Disparities in COVID-19 Telehealth Access, Use?” Patient Engagement HIT, Updated September 3, 2020. [Online]. Available: https://patientengagementhit.com/news/are-there-health-disparities-in-covid-19-telehealth-access-use

[4] M. Hackett, “Study reveals inequalities in telehealth usage across demographic groups,” Mobi Health News, Updated October 5, 2020. [Online]. Available: https://www.mobihealthnews.com/news/study-reveals-inequalities-telehealth-usage-across-demographic-groups

[5] M. Clair, B. W. Clair, and W. K. Clair, “Unless it’s done carefully, the rise of telehealth could widen health disparities,” Stat, Updated June 26, 2020. [Online]. Available: https://www.statnews.com/2020/06/26/unless-its-done-carefully-the-rise-of-telehealth-could-widen-health-disparities/

[6] M. W. Katzow, C. Steinway, and S. Jan, “Telemedicine and Health Disparities During COVID-19,” Pediatrics Perspectives, vol. 146, no. 2, e20201586, August 2020. [Online]. Available: https://doi-org.stanford.idm.oclc.org/10.1542/peds.2020-1586