Challenges and Strategies for Promoting Health Equity in Virtual Care: Protocol for a Scoping Review of Reviews

Abstract

Background The rapid virtualization of health services during the COVID-19 pandemic has drawn increasing attention to the impact of virtual care technologies on health equity. In some circumstances, virtual care initiatives have been shown to increase health disparities, as individuals from underserved communities are less likely to benefit from such initiatives. Objective The purpose of this paper is to describe a protocol for a scoping review of reviews that aims to map review-level evidence that describes challenges and strategies for promoting effective engagement with virtual care technologies among underserved communities. Methods Our methodology was adapted from seminal scoping review guidelines provided by Arksey and O’Malley, Levac at al, Colquhoun et al, and the Joanna Briggs Institute. Our search strategy was developed for the following databases: MEDLINE (on Ovid), EMBASE (on Ovid), CINAHL (on EBSCO), Scopus, and Epistemonikos. Supplementary searches will include the use of Google Scholar and reference tracking. Each citation will be independently screened by 2 researchers at the title and abstract level, and full-text screening will be performed in accordance with our eligibility criteria. The eligibility criteria focused on the inclusion of methods-driven reviews (ie, systematic reviews, scoping reviews, meta-analyses, realist reviews, and critical interpretative syntheses) to enhance rigor and quality. Other inclusion criteria included a focus on virtual care services that facilitate bidirectional patient-provider communication (ie, video, telephone, and asynchronous messaging visits) for underserved populations (ie, those who experience social disadvantage due to race, age, income, and other factors related to the social determinants of health). Results This scoping review of reviews will provide a broad overview of identified challenges associated with the accessibility of virtual health care services among underserved communities. In addition, strategies for improving the access to, uptake of, and engagement with virtual care technologies among underserved communities will be identified. The knowledge synthesized from this review will aid in developing and implementing virtual services that acknowledge the unique needs of populations who experience barriers to care and disproportionately worse health outcomes. The results will also inform gaps in current research. Conclusions The rapid shift toward virtual health services has highlighted the urgent need to critically examine the intersection of virtual care and health equity. Although technology-driven innovations in health care generally aim to improve access, quality, and health outcomes, it is also possible for these innovations to produce intervention-generated inequities. Assessing current review-level evidence on the key challenges and strategies for improving the application of virtual care in underserved communities is imperative for ensuring that virtual care benefits all populations. International Registered Report Identifier (IRRID) PRR1-10.2196/22847

Telehealth in Primary Healthcare: A Portrait of its Rapid Implementation during the COVID-19 Pandemic

“…It is essential that the pandemic response and any subsequent reorganization of PHC do not exacerbate already significant health disparities between privileged and underserved patients. Telehealth has the potential to improve effectiveness and efficiency, but it can also introduce new risks and amplify existing inequalities (SPOR PIHCI Canada n.d.; Crawford and Serhal 2020;Fujioka et al 2020;Hashiguchi 2020;Nouri et al 2020;Srinivasan et al 2020;Wijesooriya et al 2020). Since the beginning of the pandemic, follow-up protocols for patients with chronic diseases, such as diabetes, and hypertension, have been developed by experts to secure telecare practices (Kiran et al 2020;Omboni et al 2020).…”

“…Some studies report confidentiality issues and inequities based on access to or ability to use technology, which poses a risk of excluding certain groups, such as the elderly ( Shankar et al 2020 ; Srinivasan et al 2020 ; Wijesooriya et al 2020 ) and vulnerable populations (e.g., people living in rural areas or with low income, linguistic or ethnic minorities, etc.) ( Crawford and Serhal 2020 ; Fujioka et al 2020 ; Nouri et al 2020 ). Establishing a reliable diagnosis is also challenging due to limitations on the information that can be gathered, including the lack of physical examination during a telehealth consultation ( Srinivasan et al 2020 ).…”

Telehealth challenges during COVID-19 as reported by primary healthcare physicians in Quebec and Massachusetts

“…Other identified disadvantages of telehealth include the risk of compromised confidentiality, as well as patients’ unequal access to and capacity for using technology, such that certain populations risk being excluded from this type of care, such as elderly [ 4 , 11 , 13 ] and vulnerable populations (e.g., persons living in rural areas or with low income, ethnic minorities, allophones, etc.) [ 15 – 17 ]. Another problem with telehealth is the inability to conduct direct physical examinations [ 4 ].…”

Telehealth Challenges During COVID-19 As Reported by Primary Healthcare Physicians in Quebec and Massachusetts

“…Other identi ed disadvantages of telehealth include the risk of compromised con dentiality, as well as patients' unequal access to and capacity for using technology, such that certain populations risk being excluded from this type of care, such as elderly (4,12,14) and vulnerable populations (e.g., persons living in rural areas or with low income, ethnic minorities, allophones, etc.) (17)(18)(19). Another problem with telehealth is the inability to conduct direct physical examinations (4).…”