Age, racial inequities in access to virtual nephrology visits highlight need for support
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A survey of patients scheduled for nephrology telemedicine visits at University of Pennsylvania-affiliated clinics revealed age and racial inequities in the likelihood of completing virtual visits.
More specifically, the survey — which was administered after local shutdown mandates had been implemented due to the COVID-19 pandemic — showed older patients had less access to video telehealth than younger patients, with older and “non-white” individuals needing more support to access the internet.
“These findings are especially important given the higher prevalence of kidney disease among racial minorities and older populations, and also underscore the importance of explicitly assessing patients’ telemedicine capabilities in order to deliver effective and quality care,” Nwamaka D. Eneanya, MD, MPH, of the Perelman School of Medicine, and colleagues wrote.
A total of 298 patients scheduled for either general nephrology or transplant visits completed the survey, with researchers noting those scheduled for transplant visits were younger (mean age of 52 years vs. 57 years) and less likely to speak English (90% vs. 97%).
The survey assessed access to video telehealth utilizing the Pew Research Center’s Mobile Technology and Home Broadband 2019 report, while internet support needs were assessed by responses to the question, “If you use the Internet regularly, do you do it yourself or with help?”
Findings indicated patients who could access telehealth visits — 98% of which utilized a smartphone, iPad/tablet or computer — were younger (median age was 55 years compared with 68 years) and more likely to speak English (95% vs. 83%) than those without access.
Further, after adjusting for sex, race, marital status, language and visit type, older age was significantly associated with having less access to telehealth (adjusted odds ratio = 0.91).
Regarding internet access, 79% reported using the internet by themselves while 21% reported needing help.
Here, researchers again noted inequities in access, with patients who needed help having an older mean age than those who used the internet by themselves (mean age of 60 years vs. 53 years); results of the adjusted analysis showed age 65 years or older and “non-white” race were both associated with needing help.
“For some older and racial minority patients, structural barriers such as financial restraints or lack of social support at home may greatly influence Internet access and ultimately determine whether care occurs virtually [vs.] in the office or emergency room ... Given these data, ambulatory nephrology practices utilizing telemedicine video visits during the COVID-19 pandemic and beyond should employ strategies to assess patient readiness at the time a visit is scheduled,” Eneanya and colleagues concluded. “These include asking screening questions about patients’ social support and their preferred device for Internet access. Targeted training to patients who require more support may also help streamline virtual visits.”
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