Racial, socioeconomic gaps apparent in telemedicine
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Older, Asian and non-English-speaking patients were less likely to use telemedicine during the early days of the pandemic, according to a study published in JAMA Network Open.
Researchers also found that Black, Latinx and poorer patients were less likely to use video during telemedicine visits, as opposed to the phone. The findings suggest there are gaps in telemedicine care that may require attention, the researchers said.
“We have seen that there have been advantages to telemedicine, but we have a fairly unique opportunity right now to build our telemedical system of delivery as we are scaling it,” Srinath Adusumalli, MD, MSc, FACC, assistant professor of clinical medicine and assistant chief medical information officer for connected health strategy and applications at The University of Pennsylvania School of Medicine, told Healio.
“Part of that is that we need to make sure we are reaching all of the patients that we serve equitably,” Adusumalli said. “Relying on the use of technology to maintain access to care brings that into a particular light because of concerns regarding the digital divide.”
Adusumalli and colleagues conducted a retrospective cohort study of patients scheduled for specialty ambulatory clinics and primary care telemedicine visits in the University of Pennsylvania Health System. They reviewed medical records for the patients between March 16, 2020, and May 11, 2020, and identified the patients’ age, race, language, sex, median income, and type of insurance. The researchers then examined associations between sociodemographic factors, telemedicine use and video telemedicine use.
They identified 80,780 patients who completed telemedicine visits during the study period. A total of 45.6% of the visits were performed via video and 56.9% were conducted via phone. Being aged 55 to 64 years (adjusted OR = 0.85; 95% CI, 0.83-0.88), 65 to 74 years (aOR = 0.75; 95% CI, 0.72-0.78) and 75 years or older (aOR =0.67; 95% CI, 0.64-0.7) was associated with fewer completed telemedicine visits. Being Asian (aOR = 0.69; 95% CI, 0.66-0.73), a non-English-language speaker (aOR = 0.84; 95% CI, 0.78-0.9) and having Medicaid (aOR = 0.93; 95% CI, 0.89-0.97) also were associated with fewer telemedicine visits.
Adusumalli said that although telemedicine has existed for years, the method of scaling the technology is “relatively new” and offers researchers an opportunity to improve as they build.
“It is not necessarily that using telemedicine reduces access to care — it can potentially increase access to care — it is just that the systems that we design have to be designed with that goal in mind,” he said.
Adusumalli also said that one of the benefits of telemedicine is that it allows providers to see a patient’s living context, offering insight into details like how they organize their medications.
“The increase in utilization of telemedicine has been helpful for being able to maintain access to care while maintaining safety from a physical distancing perspective during the COVID-19 pandemic,” he said. “Along with that, we’ve also seen some of the benefits of telemedicine that involve convenience — particularly for patients with regard to being able to access visits without coming directly into the physical setting of a hospital.”
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