Telemedicine growth: Not all demographics are equally enthusiastic
Those who were older, female, Black, Latnix or had lower household income were less likely to use telemedicine, according to a recent study.
The use of telemedicine has increased significantly since the beginning of the pandemic last spring. However, participation varies by socioeconomic group, according to a new study reported by the Journal of the American Medical Association.
The study looked at more than 148,000 patients scheduled for primary care and medical specialty ambulatory telemedicine visits at a large academic health system during the early phase of the pandemic. The research team from the University of Pennsylvania health system compared the demographic characteristics of patients who completed a telemedicine encounter (either by phone or video) with those who were scheduled for one but did not complete it.
- Patients who were older, Asian, spoke a first language other than English or were Medicaid recipients were independently associated with fewer completed telemedicine visits.
- Those who were older, female, Black, Latnix or had lower household income were associated with lower use of video for telemedicine care.
“Telemedicine has the potential to be leveraged to increase access to care among patient groups that may have traditionally faced barriers to in-person care,” researchers wrote. “However, we must be intentional with implementation to ensure that all patients are equipped to effectively participate in telemedicine care.”
Related: As telehealth surges, rural areas being left behind
COVID-19 uprooted conventional health-care delivery for routine ambulatory care, requiring health systems to rapidly adopt telemedicine capabilities, according to the report. In response, the Centers for Medicare & Medicaid Services expanded reimbursement for ambulatory visits via telemedicine interactive communications systems, yet full reimbursement initially was restricted to visits using video, as opposed to telephone only.
Although more recent regulations have improved reimbursements for telephone-only visits, there still is a lack of complete payment parity across payers for video visits. Given this, during the initial stage of the COVID-19 pandemic, many ambulatory clinicians transitioned to near-exclusive use of telemedicine, with a preference for video visits.
The use of technology to maintain access to outpatient care raises important equity concerns. The digital divide has been well documented, with lower rates of technology and broadband adoption among older patients, racial/ethnic minority groups, and those of lower socioeconomic status.
“The COVID-19 pandemic has required a dramatic shift in health-care delivery, necessitating a new reliance on telemedicine,” researchers concluded. “As we develop and refine our telemedicine practice, we must intentionally design our system to mitigate inequity.
Engagement with community members from vulnerable populations to design and tailor connected health technologies is essential to ensure accessibility for all patients.
“Although many have anxiously awaited a return to `normal,’ we must acknowledge that our previous normal was a U.S. health-care system and digital connectivity landscape fraught with inequity. As we build our telemedical health system, which is likely here to stay, a new normal must prioritize the needs of those who have been historically marginalized to ensure that health equity is achieved.”
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