Advancing Digital Health Equity: A Policy Paper of the Infectious Diseases Society of America and the HIV Medicine Association

Abstract

The SARS-CoV-2 virus pandemic has revolutionized the practice of ambulatory medicine, triggering rapid dissemination of digital healthcare modalities, including synchronous video visits. However, social determinants of health, such as age, race, income, and others, predict readiness for telemedicine and individuals who are not able to connect virtually may become lost to care. This is particularly relevant to the practice of Infectious Diseases (ID) and HIV Medicine, as we care for high proportions of individuals whose health outcomes are affected by such factors. Furthermore, delivering high-quality clinical care in ID and HIV practice necessitates discussion of sensitive topics, which is challenging over video without proper preparation. We describe the “digital divide,” emphasize the relevance to ID and HIV practice, underscore the need to study the issue and develop interventions to mitigate its impact, and provide suggestions for optimizing telemedicine in ID and HIV clinics.

Recommendations for Health Equity and Virtual Care Arising From the COVID-19 Pandemic: Narrative Review

“…Recommendations at the level of health care organizations and health systems have been more varied. These have included encouragement to develop quality improvement activities focused on underserved or marginalized communities [ 12 , 18 , 27 ], educational initiatives for providers and leaders [ 12 , 23 , 29 , 33 ], and the collection of metrics that provide insight into equity-related outcomes [ 12 ]. Specific advice to clinicians has included strategies such as carefully planning a mix of in-person and virtual visits for clients especially at risk of poor health outcomes during the pandemic [ 25 ], and using telephone-based visits (over video visits) when a patient has access to a telephone but not a device that would enable a video visit [ 25 , 26 , 28 , 29 ].…”

“…At the level of policy and government, recommendations have focused on strategies for health policy makers and health care funders to enable access both to the infrastructure required for patients to participate in virtual care (ie, inclusive design standards, broadband internet, and digital devices) and the availability of virtual care services to entire populations (eg, by appropriately reimbursing virtual care) [13,15,23,25,[30][31][32][33]. In addition, policy-focused recommendations have emphasized the clarity of public health messaging about COVID-19 and related restrictions, and the role of digital technologies in enhancing the accuracy and reach of such messaging [24,29].…”

Effects of coronavirus disease 2019 (COVID-19) pandemic on antimicrobial prevalence and prescribing in a tertiary hospital in Singapore

“…This is in stark contrast to 71.9%, reported by Langford et al in a recently published meta-analysis and 71% reported by Nori et al during the March to May pandemic surge period in New York [ 10 , 11 ]. This may be accounted by rapid confirmatory diagnosis of SARS-CoV-2 infection as the cause of pneumonia in our setting, and the vast majority of patients having non-severe infections [ 12 ]. To prepare for the pandemic, the AMS team was requested by the hospital management to work with hospital pharmacy to provide recommendations on alternative antimicrobial use in anticipation of possible drug shortfall.…”

Recommendations for Health Equity and Virtual Care Arising From the COVID-19 Pandemic: Narrative Review (Preprint)

“…Recommendations at the level of health care organizations and health systems have been more varied. These have included encouragement to develop quality improvement activities focused on underserved or marginalized communities [12,18,27], educational initiatives for providers and leaders [12,23,29,33], and the collection of metrics that provide insight into equity-related outcomes [12]. Specific advice to clinicians has included strategies such as carefully planning a mix of in-person and virtual visits for clients especially at risk of poor health outcomes during the pandemic [25], and using telephone-based visits (over video visits) when a patient has access to a telephone but not a device that would enable a video visit [25,26,28,29].…”