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

Abstract

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.

Disparities in telehealth use: How should the supportive care community respond?

“…At the health system level, the clinic workflows designed for in-person visits need optimization for telehealth to ensure that critical care is not missed, and team-based care is seamlessly integrated into a telehealth model. Telehealth systems: Current telehealth digital systems are complex and not designed for accessibility for older patients and for patients who may have limited digital literacy [ 25 ]. They are also not optimized for smartphone use, which is more likely to be used by low-income individuals and crucial for internet access in low- and middle-income countries.…”

“…Telehealth systems: Current telehealth digital systems are complex and not designed for accessibility for older patients and for patients who may have limited digital literacy [ 25 ]. They are also not optimized for smartphone use, which is more likely to be used by low-income individuals and crucial for internet access in low- and middle-income countries.…”

The Sociotechnical Ethics of Digital Health: A Critique and Extension of Approaches From Bioethics

“…Although considerations such as transparency and fairness in the algorithms themselves are certainly important, it is also crucial to acknowledge that the ethical salience of these issues is closely linked with the broader systems of which they are a part (47). Ethical issues at the level of application software include effectiveness, usability, inclusiveness, transparency, and other issues related to the functioning and direct use of the digital health offering (30,54).…”

“…These infrastructures include the buildings in which health care providers work when delivering virtual care, the cables and wires that enable digital signals to travel over distance, and the corporate structures of the organizations that make digital communication available (56,57). These and other infrastructures can have crucial ethical implications for digital health, where for example, a lack of high-speed internet availability precludes a particular community from accessing digital health care (54).…”

Integrated Care’s New Protagonist: The Expanding Role of Digital Health

“…Despite advances to address health and digital health equity noted above, these challenges persist and will require consistent attention and iteration of possible solutions. Shaw and colleagues offer three strategies that can help promote health equity in the context of virtual care which can be adopted even in a rapid change environment [36]:…”