Disparities In Telehealth Use Among California Patients With Limited English Proficiency

Abstract

Telehealth services that allow remote communication between the patient and the clinical team are an emerging part of care delivery. Given language barriers, patients with limited English proficiency present a unique set of challenges in integrating telehealth and ensuring equity. Using data from 84,419 respondents in the 2015-18 California Health Interview Survey, we assessed the association between limited English proficiency and telehealth use (telephone and video visits) and evaluated the impact of telehealth use on health care access and use. We found that patients with limited English proficiency had lower rates of telehealth use (4.8 percent versus 12.3 percent) compared with proficient English speakers. In weighted multivariable logistic regression, patients with limited English proficiency still had about half the odds of using telehealth. Telehealth use was associated with increased emergency department use for all patients. This study suggests that policy makers and clinicians must focus on limited English proficiency as an important dimension to promote telehealth equity and decrease digital divides. F or the 25.6 million people with limited English proficiency in the US, language barriers pose a significant challenge to their health care experience and receipt of high-quality care. 1 Patients with limited English proficiency experience significant disparities in care including increased numbers of hospitalizations, lengths-ofstay, numbers of thirty-day readmissions, and numbers of emergency department (ED) visits and decreased access to preventive services. [2][3][4][5] The equitable deployment of technology offers opportunities to ameliorate these gaps. 6 Telehealth represents an emerging technology that could bridge gaps in care. Evidence suggests that extending care beyond the clinic setting improves access. 7,8 Telehealth has been shown to improve patient satisfaction, care access, and outcomes in multiple diseases, including dermatologic conditions, diabetes, cerebrovascular disease, and alcohol use disorder. 7,9-13 National-

Genetic counselor experiences with telehealth before and after COVID‐19

“…Additional reports in non‐genetics settings reveal similar disparities in traditionally underserved populations (Eberly et al., 2020; Ferguson et al., 2021). Racial disparities in telehealth services have been noted outside of the context of COVID‐19 (Butrick et al., 2015; Rodriguez et al., 2021), suggesting a need for additional investigation into the effects of telehealth on diverse patient populations. Although genetic counselors may prefer video, patient preference and outcomes should be the driver in deciding modality of telehealth delivery.…”

COVID-19, Telehealth, and Pediatric Integrated Primary Care: Disparities in Service Use

“…Less technologically savvy caregivers or those with limited English proficiency may have challenges implementing telehealth use instructions and/or prompts, especially if limited language options are provided. Recent large-scale health access research among adults demonstrates a significant ‘digital divide’ in that patients with limited English proficiency are less likely to use telehealth ( Rodriguez et al, 2021 ). Also, because younger children may have more difficulty focusing or engaging during virtual visits compared to older children ( Dueweke et al, 2020 ), family utilization of telehealth IPC compared to in-person services may vary based on age.…”

Evaluating factors of greater patient satisfaction with outpatient cardiology telehealth visits during the COVID-19 pandemic

“…Several studies have identified barriers to telehealth adoption such as limited English proficiency, lack of access to broadband internet and higher technical proficiency required to successfully integrate telehealth into clinical practice, and it is possible that these barriers may also have limited a more diverse racial representation of patient perspectives in our study. [22][23][24] Additional research into the magnitude of these disparate findings in telehealth feedback and utilization among different racial groups, and how these differences change over time is needed.…”