Preparing Telemedicine for the Frontlines of Healthcare Equity

González, Christopher

doi:10.1007/s11606-020-05941-9

Cited by 21 publications

(24 citation statements)

References 2 publications

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“…33 Our findings also report significant variations in telemedicine use by patient race, age, sex, and insurance type, aligning with previous literature that calls attention to ongoing and exacerbated inequities associated with telemedicine expansion. 5,7,34,35 Aggregating across six service lines, we found that black/African American patients and Hispanic patients were less likely than white patients to use telemedicine for their visit. Male patients were also less likely to use telemedicine than female patients.…”

Section: Discussionmentioning

confidence: 88%

“…Regardless, it is clear that system-wide implementations of telemedicine must focus explicit and proactive attention to policies that address the social and economic structures that shape health and access to care, such as racism, resource distribution, and education access. [5][6][7] Our results have implications for policymakers who are considering the costs and benefits of reimbursing telemedicine encounters at parity with in-person encounters, which has been long understood as a mechanism for promoting adoption. 43 In the past few months, several payers have proposed to decrease or eliminate reimbursement for telephone encounters compared with video or in-person visits.…”

Section: Discussionmentioning

confidence: 99%

“…4 Although telemedicine has been critical for maintaining continuity of care in the midst of public health precautions, concerning trends related to equity and access have emerged, including disparities in race, age, and geography. [5][6][7] The widening of this digital divide has been driven by social determinants of health, including lack of access to the internet or internet-enabled devices, housing insecurity, digital literacy, medical or technological mistrust, and issues related to health care access and reimbursement. 8 The quality of telemedicine services is also dependent on a number of clinical considerations that are likely to vary by medical specialty, including patient condition and needs, the nature of necessary activities during a visit (e.g., physical examinations), patient and provider preferences, and reimbrusement.…”

mentioning

confidence: 99%

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Understanding Telemedicine's “New Normal”: Variations in Telemedicine Use by Specialty Line and Patient Demographics

Drake

Lian

Cameron

et al. 2022

Telemedicine and e-Health

114

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Background: Our objective was to examine the variation in telemedicine adoption by specialty line and patient demographic characteristics after the initial peak period of the coronavirus disease 2019 pandemic when in-person visits had resumed and visit volume returned to prepandemic levels. Materials and Methods: Aggregated encounter data were extracted for six service lines (dermatology, psychiatry, endocrinology, cardiology, orthopedics, and nonurgent primary care) in an integrated health system across three time periods:

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Section: Discussionmentioning

confidence: 88%

Section: Discussionmentioning

confidence: 99%

mentioning

confidence: 99%

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Understanding Telemedicine's “New Normal”: Variations in Telemedicine Use by Specialty Line and Patient Demographics

Drake

Lian

Cameron

et al. 2022

Telemedicine and e-Health

114

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“…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 ].…”

Section: Resultsmentioning

confidence: 99%

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

Shaw¹,

Brewer²,

Veinot³

2021

JMIR Form Res

122

117

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Background The COVID-19 health crisis has disproportionately impacted populations who have been historically marginalized in health care and public health, including low-income and racial and ethnic minority groups. Members of marginalized communities experience undue barriers to accessing health care through virtual care technologies, which have become the primary mode of ambulatory health care delivery during the COVID-19 pandemic. Insights generated during the COVID-19 pandemic can inform strategies to promote health equity in virtual care now and in the future. Objective The aim of this study is to generate insights arising from literature that was published in direct response to the widespread use of virtual care during the COVID-19 pandemic, and had a primary focus on providing recommendations for promoting health equity in the delivery of virtual care. Methods We conducted a narrative review of literature on health equity and virtual care during the COVID-19 pandemic published in 2020, describing strategies that have been proposed in the literature at three levels: (1) policy and government, (2) organizations and health systems, and (3) communities and patients. Results We highlight three strategies for promoting health equity through virtual care that have been underaddressed in this literature: (1) simplifying complex interfaces and workflows, (2) using supportive intermediaries, and (3) creating mechanisms through which marginalized community members can provide immediate input into the planning and delivery of virtual care. Conclusions We conclude by outlining three areas of work that are required to ensure that virtual care is employed in ways that are equity enhancing in a post–COVID-19 reality.

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“…We did not include mental health facilities in our analysis though they often provide a broad range of services [ 56 ]. Finally, this study documented telepsychiatry availability prior to COVID-19, which might have experienced uptick due to temporary waivers by the Centers for Medicare and Medicaid Services on originating sites for telehealth and the ability of healthcare professionals to prescribe remotely during the COVID-19 pandemic [ 57 ]. Future research is warranted to study how these policy waivers impacted telepsychiatry availabilities when nationwide hospital data on telepsychiatry during 2020 are made available.…”

Section: Discussionmentioning

confidence: 99%

Telepsychiatry adoption across hospitals in the United States: a cross-sectional study

Zhong

Harrison

et al. 2021

BMC Psychiatry

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Background Access to psychiatric care is critical for patients discharged from hospital psychiatric units to ensure continuity of care. When face-to-face follow-up is unavailable or undesirable, telepsychiatry becomes a promising alternative. This study aimed to investigate hospital- and county-level characteristics associated with telepsychiatry adoption. Methods Cross-sectional national data of 3475 acute care hospitals were derived from the 2017 American Hospital Association Annual Survey. Generalized linear regression models were used to identify characteristics associated with telepsychiatry adoption. Results About one-sixth (548 [15.8%]) of hospitals reported having telepsychiatry with a wide variation across states. Rural noncore hospitals were less likely to adopt telepsychiatry (8.3%) than hospitals in rural micropolitan (13.6%) and urban counties (19.4%). Hospitals with both outpatient and inpatient psychiatric care services (marginal difference [95% CI]: 16.0% [12.1% to 19.9%]) and hospitals only with outpatient psychiatric services (6.5% [3.7% to 9.4%]) were more likely to have telepsychiatry than hospitals with neither psychiatric services. Federal hospitals (48.9% [32.5 to 65.3%]), system-affiliated hospitals (3.9% [1.2% to 6.6%]), hospitals with larger bed size (Quartile IV vs. I: 6.2% [0.7% to 11.6%]), and hospitals with greater ratio of Medicaid inpatient days to total inpatient days (Quartile IV vs. I: 4.9% [0.3% to 9.4%]) were more likely to have telepsychiatry than their counterparts. Private non-profit hospitals (− 6.9% [− 11.7% to − 2.0%]) and hospitals in counties designated as whole mental health professional shortage areas (− 6.6% [− 12.7% to − 0.5%]) were less likely to have telepsychiatry. Conclusions Prior to the Covid-19 pandemic, telepsychiatry adoption in US hospitals was low with substantial variations by urban and rural status and by state in 2017. This raises concerns about access to psychiatric services and continuity of care for patients discharged from hospitals.

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Preparing Telemedicine for the Frontlines of Healthcare Equity

Cited by 21 publications

References 2 publications

Understanding Telemedicine's “New Normal”: Variations in Telemedicine Use by Specialty Line and Patient Demographics

Understanding Telemedicine's “New Normal”: Variations in Telemedicine Use by Specialty Line and Patient Demographics

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

Telepsychiatry adoption across hospitals in the United States: a cross-sectional study

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