Inequity in Access and Delivery of Virtual Care Interventions: A Scoping Review

Abstract

The objectives of this review were to map and summarize the existing evidence from a global perspective about inequity in access and delivery of virtual care interventions and to identify strategies that may be adopted by virtual care services to address these inequities. We searched MEDLINE, EMBASE, and CINAHL using both medical subject headings (MeSH) and free-text keywords for empirical studies exploring inequity in ambulatory services offered virtually. Forty-one studies were included, most of them cross-sectional in design. Included studies were extracted using a customized extraction tool, and descriptive analysis was performed. The review identified widespread differences in accessing and using virtual care interventions among cultural and ethnic minorities, older people, socioeconomically disadvantaged groups, people with limited digital and/or health literacy, and those with limited access to digital devices and good connectivity. Potential solutions addressing these barriers identified in the review included having digitally literate caregivers present during virtual care appointments, conducting virtual care appointments in culturally sensitive manner, and having a focus on enhancing patients’ digital literacy. We identified evidence-based practices for virtual care interventions to ensure equity in access and delivery for their virtual care patients.

Understanding COVID: Collaborative Government Campaign for Citizen Digital Health Literacy in the COVID-19 Pandemic

“…One of the main challenges of the strategy was to reach as many vulnerable people of different ages as possible, as has been done in similar studies and interventions [ 15 , 16 , 17 , 18 , 19 , 20 , 21 , 22 , 23 , 24 , 25 ], but at the same time minimizing the technological gap that could leave someone behind, which is a common problem when trying to reach a vulnerable population using information technologies [ 9 , 26 , 27 ]. To do this, everyday technology tools already existing in homes, such as tablets and smartphones, were used, with no need for additional installation of complex programs.…”

“…also required efforts to convey information clearly and understandably. However, with the passage of time, the transmission of information and the training of citizens from the public administrations became increasingly complex, a circumstance that especially affected the most vulnerable groups [ 9 ], and the first signs of “pandemic fatigue” in the general population began to show. This is why the WHO urged the inclusion of four recommendations in dissemination campaigns and actions summarized in Figure 1 [ 10 ].…”

Nurse-led virtual interventions in managing chronic diseases: a protocol for a systematic review of randomised controlled trials

“…Virtual care interventions as a way of monitoring patients in their homes have received particular attention during the COVID-19 pandemic. Research has identified that virtual care interventions are generally used to facilitate counselling, online learning, information sharing and health outcomes tracking 28. The modalities of virtual care interventions include teleconferencing, video conferencing, emails, messaging, health apps, personal health records, patient portals and eHealth services used via the internet 28.…”

“…Research has identified that virtual care interventions are generally used to facilitate counselling, online learning, information sharing and health outcomes tracking 28. The modalities of virtual care interventions include teleconferencing, video conferencing, emails, messaging, health apps, personal health records, patient portals and eHealth services used via the internet 28. Previous studies have highlighted that virtually delivered healthcare is cost-effective 29–31.…”

A comparison of virtual and in person delivery of a full meal replacement program for obesity

“…Additionally, older adults may have more difficulty accessing virtual care if done through online videoconferencing 24 . Other barriers, such as digital literacy or socioeconomic status, might make virtual care less effective for some patients 25 …”