Telehealth’s Double-Edged Sword: Bridging or Perpetuating Health Inequities?

Barnett, Katherine Gergen; Mishuris, Rebecca G.; Williams, Charles T.; Bragg, Alexa; Semenya, Afi M; Baldwin, Marielle; Howard, Jessica M.; Wilson, Stephen; Srinivasan, Jayakanth

doi:10.1007/s11606-022-07481-w

Cited by 15 publications

(13 citation statements)

References 14 publications

(8 reference statements)

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“…Importantly, consideration of how these virtual models of care may impact underserved populations is required. While telerehabilitation may benefit those living in regional areas by improving access, it can also increase disparity for those with poor digital or health literacy, limited English proficiency, or from low socio-economic backgrounds [ 50 ]. Moreover, data is currently lacking to model the cost-effectiveness of hybrid cardiac rehabilitation programs for traditionally underserved groups such as First Nations people, culturally diverse communities or rural populations.…”

Section: Discussionmentioning

confidence: 99%

Hybrid cardiac telerehabilitation for coronary artery disease in Australia: a cost-effectiveness analysis

Senanayake

Halahakone

Abell

et al. 2023

BMC Health Serv Res

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Background Traditional cardiac rehabilitation programs are centre-based and clinically supervised, with their safety and effectiveness well established. Notwithstanding the established benefits, cardiac rehabilitation remains underutilised. A possible alternative would be a hybrid approach where both centre-based and tele-based methods are combined to deliver cardiac rehabilitation to eligible patients. The objective of this study was to determine the long-term cost-effectiveness of a hybrid cardiac telerehabilitation and if it should be recommended to be implemented in the Australian context. Methods Following a comprehensive literature search, we chose the Telerehab III trial intervention that investigated the effectiveness of a long-term hybrid cardiac telerehabilitation program. We developed a decision analytic model to estimate the cost-effectiveness of the Telerehab III trial using a Markov process. The model included stable cardiac disease and hospitalisation health states and simulations were run using one-month cycles over a five-year time horizon. The threshold for cost-effectiveness was set at $AU 28,000 per quality-adjusted life-year (QALY). For the base analysis, we assumed that 80% completed the programme. We tested the robustness of the results using probabilistic sensitivity and scenario analyses. Results Telerehab III intervention was more effective but more costly and was not cost-effective, at a threshold of $28,000 per QALY. For every 1,000 patients who undergo cardiac rehabilitation, employing the telerehabilitation intervention would cost $650,000 more, and 5.7 QALYs would be gained, over five years, compared to current practice. Under probabilistic sensitivity analysis, the intervention was cost-effective in only 18% of simulations. Similarly, if the intervention compliance was increased to 90%, it was still unlikely to be cost-effective. Conclusion Hybrid cardiac telerehabilitation is highly unlikely to be cost-effective compared to the current practice in Australia. Exploration of alternative models of delivering cardiac telerehabilitation is still required. The results presented in this study are useful for policymakers wanting to make informed decisions about investment in hybrid cardiac telerehabilitation programs.

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Section: Discussionmentioning

confidence: 99%

Hybrid cardiac telerehabilitation for coronary artery disease in Australia: a cost-effectiveness analysis

Senanayake

Halahakone

Abell

et al. 2023

BMC Health Serv Res

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“…Furthermore, virtual visits should still be consistent with standards of care, including providing mental health screening, IPV screening, and vaccine counseling. Issues of digital redlining and digital fluency, which impact marginalized populations, particularly immigrant women, 37 , 38 require structural interventions, such as discounts for internet and cellular services, equity-focused technology monitoring programs, and expansion of broadband connectivity. 39 In the meantime, health care staff should assess barriers to virtual care before visits and offer resources or work directly with patient's support networks as participants identified support networks as helpful in overcoming technological barriers.…”

Section: Discussionmentioning

confidence: 99%

Disruptions in Sexual and Reproductive Health Care Service Delivery for Immigrants During COVID-19

Samari

Wurtz

Karunaratne

et al. 2023

Women's Health Reports

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Purpose: To provide perspectives from heterogenous cisgender immigrant women and service providers for immigrants in New York City (NYC) on how restrictive sexual and reproductive health (SRH) care delivery environments during COVID-19 shape immigrant's access to health care and health outcomes to generate insights for clinical practices and policies for immigrant women's health care needs. Methods: A qualitative study was conducted in 2020 and 2021, including in-depth interviews with 44 immigrant women from different national origins and 19 direct service providers for immigrant communities in NYC to explore how immigrants adapted to and were impacted by pandemic-related SRH care service delivery barriers. Interviews were coded and analyzed using a constant comparative approach. Results: Pandemic-related delays and interrupted health care, restrictive accompaniment policies, and the transition from in-person to virtual care compounded barriers to care for immigrant communities. Care delays and interruptions forced some participants to live with untreated health conditions, resulting in physical pain and emotional distress. Participants also experienced challenges within the health care system because of changes to visitor policies that restricted the accompaniment of family members or support persons. Some participants experienced difficulties accessing telehealth and technology, while others welcomed the flexibility given the demands of frontline work and childcare. Conclusions: To mitigate the health and social implications of increasingly restrictive immigration, reproductive, and social policies, clinical practices like expanding access to care for all immigrants, engaging immigrant communities in health care institutions policies and practices, and integrating immigrant's support networks into care play an important role.

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“…While telemedicine holds the promise to expand access to health care, it also has the potential to worsen existing structural inequities. 2 Among the major barriers is a lack of high-speed internet or modern telecommunications devices-otherwise known as the "digital divide." 3 Urban and rural low-income and racial and ethnic minoritized communities face significant disparities in technology access and literacy.…”

Section: Background and Significancementioning

confidence: 99%

A Prescription for Internet: Feasibility of a Tablet Loaner Program to Address Digital Health Inequities

et al. 2023

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Objective: The COVID-19 pandemic accelerated the adoption of telehealth technologies. Persistent disparities in telecommunication devices, internet connectivity, and digital literacy, however, undermine the potential for telemedicine to reduce barriers to healthcare access. Health systems may have a role in addressing these structural inequities. We describe the operationalization and feasibility of an internet-enabled tablet loaner program at a freestanding children’s hospital. Methods: Between October 2020-October 2021, pediatricians enrolled families through ambulatory clinics at an academic urban freestanding children’s hospital. Eligibility criteria included difficulty accessing virtual care due to lack of stable internet or device. Tablets featured an unlimited data package, access to the patient portal, and virtual visit platform. A private technology company managed device configuration and distribution. To characterize program impact, we compared the proportion of completed clinical encounters during the intervention compared with a pre-intervention period (March 2020-October 2020) and conducted a qualitative survey with program participants. Participant and visit characteristics were obtained from the electronic medical record and summarized with descriptive statistics. Results: A total of 111 families participated in the tablet loaner program, the majority of whom were Hispanic (51.4%) and Black, non-Hispanic (21.6%) and publicly insured (64.9%). Between the pre-intervention and intervention period, there was a significant increase in completed video- and phone-based virtual visits (75.3% vs. 79.1%, p=0.038). The proportion of video-based only visits increased from 82.9% to 88.9 %. p < 0.001). Families reported that the tablet improved the patient’s ability to receive medical care (93.7%) and was easy to use (93.9%). Conclusion: The tablet loaner initiative was associated with an improvement in markers of virtual visit engagement and healthcare experience. Efforts to expand telemedicine equity must consider technological access and digital literacy as well as broad coalitions across industry, government, and community organizations.

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Telehealth’s Double-Edged Sword: Bridging or Perpetuating Health Inequities?

Cited by 15 publications

References 14 publications

Hybrid cardiac telerehabilitation for coronary artery disease in Australia: a cost-effectiveness analysis

Hybrid cardiac telerehabilitation for coronary artery disease in Australia: a cost-effectiveness analysis

Disruptions in Sexual and Reproductive Health Care Service Delivery for Immigrants During COVID-19

A Prescription for Internet: Feasibility of a Tablet Loaner Program to Address Digital Health Inequities

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