Challenges and strategies for promoting health equity in virtual care: findings and policy directions from a scoping review of reviews

Fujioka, Jamie; Thomas-Jacques, Tyla; Vera, Kristina De; Challa, Priyanka; Silva, Ryan de; Fuller, Kaitlin; Shahid, Simone; Hogeveen, Sophie; Chandra, Shivani; Bhatia, R. Sacha; Seto, Emily; Shaw, James

doi:10.1093/jamia/ocac022

Cited by 31 publications

(27 citation statements)

References 60 publications

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“…The use of technology required to access virtual care raises important equity concerns. Previous studies have reported lower rates of technology adoption and increased barriers to virtual care among older patients, racial and ethnic minority groups, and those of lower socioeconomic status [ 21 – 24 ]. In our study, patients accessing virtual urgent care services were mostly young, well educated, English-speaking females with a primary care provider, suggesting access to virtual care may exacerbate existing health inequities among patients using virtual care compared to the general population.…”

Section: Discussionmentioning

confidence: 99%

Demographic characteristics, outcomes and experience of patients using virtual urgent care services from 14 emergency department led sites in Ontario

et al. 2022

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Introduction As part of the COVID-19 pandemic response, the Ontario Ministry of Health funded a virtual care pilot program intended to support emergency department (ED) diversion of patients with low acuity complaints and reduce the need for face-to-face contact. The objective was to describe the demographic characteristics, outcomes and experience of patients using the provincial pilot program. Methods This was a prospective cohort study of patients using virtual care services provided by 14 ED-led pilot sites from December 2020 to September 2021. Patients who completed a virtual visit were invited by email to complete a standardized, 25-item online survey, which included questions related to satisfaction and patient-reported outcome measures. Results There were 22,278 virtual visits. When patients were asked why they contacted virtual urgent care, of the 82.7% patients who had a primary care provider, 31.0% said they could not make a timely appointment with their family physician. Rash, fever, abdominal pain, and COVID-19 vaccine queries represented 30% of the presenting complaints. Of 19,613 patients with a known disposition, 12,910 (65.8%) were discharged home and 3,179 (16.2%) were referred to the ED. Of the 2,177 survey responses, 94% rated their overall experience as 8/10 or greater. More than 80% said they had answers to all the questions they had related to their health concern, believed they were able to manage the issue, had a plan they could follow, and knew what to do if the issue got worse or came back. Conclusions Many presenting complaints were low acuity, and most patients had a primary care provider, but timely access was not available. Future work should focus on health equity to ensure virtual care is accessible to underserved populations. We question if virtual urgent care can be safely and more economically provided by non-emergency physicians. Supplementary Information The online version contains supplementary material available at 10.1007/s43678-022-00407-9.

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Section: Discussionmentioning

confidence: 99%

Demographic characteristics, outcomes and experience of patients using virtual urgent care services from 14 emergency department led sites in Ontario

et al. 2022

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“…A scoping review of scoping reviews also illustrated the complexities of engaging individuals in web-based health services, recognizing how an individual’s culture and perceived effectiveness of telehealth technologies is intertwined not only with digital literacy but also the social and structural determinants of health [ 42 ]. It is likely that there are other factors that we did not measure, which are stronger predictors of completion of the VC delivery mode (eg, digital literacy and trust in technology).…”

Section: Discussionmentioning

confidence: 99%

Enrollment and Completion Characteristics for Novel Remote Delivery Modes of the Self-management Programs During the COVID-19 Pandemic: Exploratory Analysis

Pullyblank¹,

Atav²

2022

JMIR Form Res

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Background In-person, evidence-based, peer-facilitated chronic disease self-management programs have been shown to be effective for individuals from a variety of backgrounds, including rural and minority populations and those with lower socioeconomic status. Based in social learning theory, these programs use group processes to help participants better manage their chronic disease symptoms and improve their quality of life. During the pandemic, these in-person programs were forced to rapidly transition to remote delivery platforms, and it was unclear whether doing so increased disparities within our rural population. Objective The objectives of this analysis were to ascertain self-management program enrollment and completion characteristics between 2 remote delivery platforms, as well as determine the individual level characteristics that drove enrollment and completion across delivery modes. Methods We analyzed enrollment and completion characteristics of 183 individuals who either enrolled in a self-management workshop delivered through a web-based videoconference (VC) system or through a traditional, audio-only conference call (CC) offered by our health care network between April and December 2020. Chi-square tests of association were used to describe the characteristics of and differences between groups. Logistic regression analysis was used to determine significant predictors of enrollment and completion. Results Those who enrolled in the VC platform were significantly likelier to be younger and college educated than those who enrolled in the CC platform. Those who completed a program, regardless of delivery mode, were likelier to be older and college educated than those who did not complete a program. Multivariate analyses indicated that of those enrolled in the CC platform, completers were likelier to not be enrolled in Medicaid. Among those enrolled in the VC platform, completers were older, college graduates, female, and likelier to have reported poorer health than those who did not complete the program. Conclusions The transition of self-management programs to remote delivery modes, particularly to those that rely on VC platforms, revealed that certain demographic groups may no longer be able or willing to access the service. Efforts need to be made to increase engagement in remote self-management workshops. In addition, equivalent quality services that do not rely on a digital platform must continue to be offered in order to promote health equity.

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“…Measuring barriers and enablers to telehealth participation as well as appropriate uses and how these vary across places and populations may help address health care inequities. These health care and broadband infrastructure metrics may help provide the information needed to improve equity through telehealth 30…”

Section: Understanding the Evidence Base For Telehealth In Us Public ...mentioning

confidence: 99%

Telehealth and Public Health Practice in the United States—Before, During, and After the COVID-19 Pandemic

Neri

Whitfield

Umeakunne

et al. 2022

Journal of Public Health Management and Practice

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Telehealth is the use of electronic information and telecommunication technologies to provide care when the patient and the provider are not in the same room at the same time. Telehealth accounted for less than 1% of all Medicare Fee-for-Service outpatient visits in the United States in 2019 but grew to account for 46% of all visits in April 2020. Changes in reimbursement and licensure policies during the COVID-19 pandemic appeared to greatly facilitate this increased use. Telehealth will continue to account for a substantial portion of care provided in the United States and globally. A better understanding of telehealth approaches and their evidence base by public health practitioners may help improve their ability to collaborate with health care organizations to improve population health. The article summarizes the Centers for Disease Control and Prevention's (CDC's) approach to understanding the evidence base for telehealth in public health practice, possible applications for telehealth in public health practice, and CDC's use of telehealth to improve population health.

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Challenges and strategies for promoting health equity in virtual care: findings and policy directions from a scoping review of reviews

Cited by 31 publications

References 60 publications

Demographic characteristics, outcomes and experience of patients using virtual urgent care services from 14 emergency department led sites in Ontario

Demographic characteristics, outcomes and experience of patients using virtual urgent care services from 14 emergency department led sites in Ontario

Enrollment and Completion Characteristics for Novel Remote Delivery Modes of the Self-management Programs During the COVID-19 Pandemic: Exploratory Analysis

Telehealth and Public Health Practice in the United States—Before, During, and After the COVID-19 Pandemic

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