Accessibility and utilisation of telehealth services among older adults during COVID‐19 pandemic in the United States

Abstract

The removal of regulatory and reimbursement barriers during the COVID-19 pandemic in the United States presented opportunities to explore the potential of telehealth to improve access to and use of healthcare among underserved populations.Therefore, we examined factors associated with accessibility and utilisation of telehealth among older adults during the COVID-19 pandemic. We analysed the nationally representative Medicare Current Beneficiary Survey COVID-19 Supplement File of community-dwelling Medicare beneficiaries aged ≥65 years (n = 5,189), administered from 5 October 2020, through 15 November 2020. Two survey-weighted multivariable logistic regression models were used to assess the association between factors (i.e., socio-demographics, co-morbidities and digital access/literacy) and whether (1) beneficiaries' regular providers offered telehealth during the COVID-19 pandemic, and (2) those being offered telehealth used it. Furthermore, subgroup analyses by residing area and income status were conducted. Of study beneficiaries, 83.6% reported their regular providers offered telehealth during COVID-19. Disparities in accessibility of telehealth by sociodemographic status were observed [e.g., those living in a non-metro area (versus metro) were 7.1% (marginal effect [ME] = −7.1%; p < 0.01) less likely to report accessibility of telehealth]. Beneficiaries who had no access to internet (ME = −8.2%; p < 0.001) and had not participated in video/voice calls/conferencing prior (versus participated) (ME = −6.6%; p < 0.001) were less likely to report having access to telehealth. Among those being offered telehealth services, 43.0% reported using telehealth services. Hispanic and Non-Hispanic Black beneficiaries (e.g., Black versus White; ME = 11.3%; p < 0.01) and those with co-morbidities (versus 0-1 condition) (e.g., 2-3 co-morbidities, ME = 7.3%; p < 0.01) were more likely to report using telehealth services when offered. Similar results were observed in the subgroup analyses regarding disparities in accessibility and utilisation of telehealth. The accessibility and utilisation of telehealth have increased amidst the pandemic; however, disparities in accessibility of telehealth were observed. A telehealth triage protocol is needed to ensure underserved patients continue to receive appropriate care.

Acceptance of Social Networking Sites by Older People before and after COVID-19 Confinement: A Repeated Cross-Sectional Study in Chile, Using the Theory of Planned Behaviour (TPB)

“…Due to the above, we found a modification in the strength of the variables that determine the intention to use social networks. Investigations in other countries coincide in reporting that the epidemic forced the elderly population to use more information technologies, including those related to health care services and applications for physical training and messaging [ 29 , 30 ]. Other researchers agree that older adults embraced digital technology and had sufficient knowledge and support, but felt apprehensive and faced financial barriers to technology adoption [ 31 ].…”

“…In addition to socioeconomic barriers, other variables that influenced the use of these technologies in older people during confinement were access to the Internet and previous use of video calls [ 29 ], level of education, digital literacy, and attitudes toward oneself aging [ 30 , 32 , 33 ]. According to international research, the benefits obtained were related to improvements in mental health, decreased loneliness, strengthening of physical capacity, mood, and memory enhancements [ 34 , 35 ].…”

Access to care through telehealth among U.S. Medicare beneficiaries in the wake of the COVID-19 pandemic

“…In contrast to previous studies ( 3 , 18 , 49 ), we analyzed related factors in a more inclusive fashion for ranking variables and identifying complex interactions. After adjustment for different factors, the discoveries could be more reproducible.…”

COVID-19 and Cardiometabolic Health: Lessons Gleaned from the Pandemic and Insights for the Next Wave

“…Furthermore, telehealth may not be optimal for cardiovascular health as labs are unavailable (e.g., lipid measurements and HbA1c) and many do not have access to a blood pressure cuff at home [42]. Finally, relying on telehealth may exacerbate disparities given inequity in access to broadband internet or telehealthenabled health systems [43]. In one study, significant racial differences were seen in those with access to telehealth visits, with Black individuals being less likely to receive telehealth visits than other groups [44].…”