30 Dec Disparities in Telemedicine Use in the COVID-19 Era
MedicalResearch.com Interview with:
Srinath Adusumalli, MD, MSc, FACC
Assistant Professor of Clinical Medicine
Division of Cardiovascular Medicine| Penn Medicine
Lauren A. Eberly, MD, MPH
Division of Cardiovascular Medicine, Department of Medicine
Hospital of the University of Pennsylvania, Philadelphia
MedicalResearch.com: What is the background for this study?
Response: The coronavirus disease 2019 (COVID-19) pandemic has uprooted conventional health care delivery for routine ambulatory care, requiring health systems to rapidly adopt telemedicine capabilities. At Penn Medicine, we wanted to ensure that as we developed a new system of telemedical care, we were reaching all of the patients we serve and access to care was maintained. As such, we undertook this study to examine utilization of care as we continued to iterate on and develop our telemedical system of care.
MedicalResearch.com: What are the main findings?
Response: We found that older patients, Asian patients, patients with Medicaid, and non-English speaking patients had lower telemedicine utilization for routine ambulatory care. Older age, female gender, Black race, Latinx ethnicity, and lower socioeconomic status were associated with lower utilization of video (as compared to telephone) for telemedicine care. These results call for immediate implementation of strategies to ensure more equitable access to telemedicine care.
It is important to note that in our study, we found that Black patients had higher completed telemedicine visits for specialty clinics, and Black and Latinx patients had higher completed telemedicine utilization overall and for primary care visits. This shows that telemedicine has potential to be leveraged to increase access to care among patient groups that may have traditionally faced barriers to in-person care.
MedicalResearch.com: What should readers take away from your report?
Response: Readers should take away that we must be intentional in developing our telemedical systems of care – and now is a great time to be doing that. Although we found inequities in access to care early in the pandemic – we can address these inequities with deliberate attention to telemedical system design. Whether it is incorporating easy methods for including interpreter systems into visits, to facilitating broadband or device access – strategies to mitigating inequities once identified should be developed, tested, and implemented alongside the overall implementation of telemedicine.
Additionally, it will be important to be able to maintain access to care through all avenues possible including video and telephone-based care. As such, regulatory and payments policies should encourage maintaining care through routes available to patients and which are suitable for their clinical care – and also encourage/provide credit for practice time/effort that should be applied to making care equitable.
MedicalResearch.com: What recommendations do you have for future research as a result of this work?
Response: Although we identified inequities in access to care, further research is needed to specifically elucidate the barriers that would be most helpful and highest yield to address as a way of mitigating those inequities. This is underway at Penn Medicine, including in qualitative fashion through surveys and interviews of our patient population. Once that is done, we need to develop and test potential interventions to ensure they truly address identified inequities as we progress with our implementation and refinement of telemedical systems of care.
Dr. Eberly and Dr. Adusumalli have no disclosures.
Eberly LA, Kallan MJ, Julien HM, et al. Patient Characteristics Associated With Telemedicine Access for Primary and Specialty Ambulatory Care During the COVID-19 Pandemic. JAMA Netw Open. 2020;3(12):e2031640. doi:10.1001/jamanetworkopen.2020.31640
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