Utilization Gaps During the COVID-19 Pandemic: Racial and Ethnic Disparities in Telemedicine Uptake in Federally Qualified Health Center Clinics

Adepoju, Omolola E.; Chae, Minji; Ojinnaka, Chinedum O.; Shetty, Sharonya; Angelocci, Tracy

doi:10.1007/s11606-021-07304-4

Cited by 81 publications

(70 citation statements)

References 24 publications

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“…Similar to previous studies [ 15 , 16 ], this study demonstrated significant ethnic differences in the adoption of telemedicine during the COVID-19 pandemic, with lower use among ethnic minorities. A recently published study [ 15 ] demonstrated lower telemedicine use among African Americans, Asians, and American Indians compared with Whites (OR 95% CI: = 0.65, 0.61, 0.69; 0.58, 0.52, 0.65; and 0.82 0.70, 0.98, respectively) during the COVID-19 pandemic. Lower use of technology for managing health was also observed among older racial and ethnic minorities before the COVID-19 pandemic [ 25 ].…”

Section: Discussionsupporting

confidence: 87%

“…Indeed, although the provision and coverage of telemedicine were substantially expanded throughout the world [ 12 , 13 ], disparities in using remote clinical services have been documented [ 4 , 6 , 14 ]. The potential contributing factors include system-related factors, such as lack of telemedicine availability and lack of insurance coverage, in addition to patient-related factors, such as ethnicity, low income, and multimorbidity [ 11 , 15 , 16 ]. Low technology literacy and limited digital access have been identified as independent factors associated with telemedicine utilization [ 17 , 18 , 19 , 20 ] and may be an additional significant barrier to remote clinical services.…”

Section: Introductionmentioning

confidence: 99%

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Factors Associated with Using Telemedicine in the Primary Care Clinics during the COVID-19 Pandemic in Israel

Reges

Feldhamer

Sagy

et al. 2022

IJERPH

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Background: The COVID-19 pandemic generated an extraordinary need for telemedicine. Objective: To identify the factors and multi-way interactions associated with telemedicine use in primary healthcare during the COVID-19 pandemic. Methods: This population-based study included all members (2,722,773) aged ≥18 years of the largest healthcare organization in Israel who used primary care clinic services between 1 March 2020 and 31 December 2021. Individuals were classified as telemedicine users (≥1 phone/video visits or asynchronous encounters) or non-telemedicine users (only in-person encounter/s). Results: Ethnicity was the most discriminative variable associated with telemedicine use, with 85% and 52% users among Jews and Arabs, respectively. Higher odds for telemedicine utilization were observed among women, residents of urban areas, those confined to home, individuals with high level of technology literacy, residents of the central area (in Jews only), young Jews, and older Arabs. Based on decision tree analysis, the segments of the population with the lowest telemedicine use were characterized by lower primary care needs and comorbidities, as well as low technology literacy. The proportion of telemedicine use in these groups was 56% and 27% in Jews and in Arabs, respectively. Conclusion: A proactive intervention program should be applied among populations who are less likely to use telemedicine in the primary care clinics, including Arabs, Jews who live in the distant periphery, and individuals with low technology literacy.

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Section: Discussionsupporting

confidence: 87%

Section: Introductionmentioning

confidence: 99%

Factors Associated with Using Telemedicine in the Primary Care Clinics during the COVID-19 Pandemic in Israel

Reges

Feldhamer

Sagy

et al. 2022

IJERPH

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“…Emergency housing information was made available for those at risk of homelessness. An urgent need arose to focus efforts on addressing loneliness and social isolation for patients and caregivers alike, and the disparities linked to loneliness in these populations were significant (Adepoju et al, 2021(Adepoju et al, , 2022Kotwal et al, 2021). GWEP-FQHC partnerships created programs to address social isolation.…”

Section: Challenge 3: New Social Determinants Of Health Gapsmentioning

confidence: 99%

Pioneering COVID-19 Pandemic Partnerships: Federally Qualified Health Centers and Geriatric Workforce Enhancement Programs Work Together to Care for Diverse Underserved Older Adults

Gibbs

Rousseau

Tumosa³

et al. 2022

Gerontology and Geriatric Medicine

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Background: The COVID-19 pandemic disproportionately affected populations served by Federally Qualified Health Centers (FQHCs), with high morbidity and mortality rates in ethnic minority older adults. In response to this pandemic, academic geriatric medicine teams through federally funded Geriatric Workforce Enhancement Program (GWEP) with FQHC partnership implemented new initiatives to improve the care for vulnerable older adults. Objectives: To describe how four FQHC/GWEP teams collaborated in caring for diverse communities of older adults during the pandemic. Methods: Four GWEPs have addressed pandemic response efforts with their respective FQHC partners. These collaborations to meet the increasing numbers of older adults seeking services, and the rising disparities exacerbated during the pandemic are delineated. Results: FQHC/GWEP partnerships enabled access to care, whether in-person or virtually to serve unmet needs of underserved older adults during the pandemic. Partnerships promoted COVID-19 education, testing, and vaccinations. Most FQHCs faced severe staffing shortages, and the digital divide challenged patients with barriers. GWEPs provided direct care, created educational materials, and developed telehealth programs. These partnerships addressed social determinants of health gaps caused by the pandemic. Conclusion: The findings demonstrate that strong partnerships between GWEPs and FQHCs mitigate health inequities for vulnerable ethnic minority and rural older adults during pandemic crises.

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“…5 FQHC administrators understood that an optimal transition to telemedicine required a considerable allocation of human capital and technology resources; otherwise, utilization of telemedicine could exacerbate existing health disparities. 6 Like many other ambulatory care providers, FQHCs experienced a profound decrease in the volume of in-person visits following the stay-at-home orders of the pandemic due to patient avoidance of in-person visits and limited patient understanding on how to use virtual care platforms.…”

Section: Introductionmentioning

confidence: 99%

Increased Revenue From Averted Missed Appointments Following Telemedicine Adoption at a Large Federally Qualified Health Center

Adepoju

Angelocci

Matuk-Villazon

2022

Health�Serv�Insights

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This study examined savings from averted missed appointments following telemedicine adoption. Data were obtained from a large Federally Qualified Health Center in Texas during the early pandemic months. Patient encounters fell into one of three categories: (1) in-person visit, (2) telemedicine alone with no support team engagement, and (3) telemedicine with previsit support team engagement for device and connectivity testing. Our findings revealed that in-person visits had a 21% missed appointment rate compared to 19% for telemedicine alone and 15% for telemedicine with previsit support. Translating the reductions following both telemedicine encounters into net reimbursement, telemedicine alone saved the Federally Qualified Health Center $16 444 per month, while telemedicine + support team reduced missed appointments and saved the clinic an additional $29 134. The revenue from averted missed appointments totaled $45 578 per month. In conclusion, telemedicine reduced missed appointments, and these averted missed appointments translated into cost-savings. Savings were more pronounced with the implementation of a support team that conducted previsit device and connectivity testing.

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Utilization Gaps During the COVID-19 Pandemic: Racial and Ethnic Disparities in Telemedicine Uptake in Federally Qualified Health Center Clinics

Cited by 81 publications

References 24 publications

Factors Associated with Using Telemedicine in the Primary Care Clinics during the COVID-19 Pandemic in Israel

Factors Associated with Using Telemedicine in the Primary Care Clinics during the COVID-19 Pandemic in Israel

Pioneering COVID-19 Pandemic Partnerships: Federally Qualified Health Centers and Geriatric Workforce Enhancement Programs Work Together to Care for Diverse Underserved Older Adults

Increased Revenue From Averted Missed Appointments Following Telemedicine Adoption at a Large Federally Qualified Health Center

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