Telemedicine in the United States Has Revealed Major Social Inequalities

In the United States, while telemedicine has helped many patients access medical care in recent months, it has also exposed many inequities in access to care, whether based on ethnicity, age, or language.

Online therapy

Since the start of the Covid-19 pandemic, the use of telemedicine has exploded. But while it has helped patients who otherwise would have given up on treatment, it has revealed significant disparities in the United States based on patient ethnicity, socioeconomic status, age, or language. That’s the finding of a study published Dec. 29 in the JAMA Open Network.

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In their study, researchers at the Perelman School of Medicine at the University of Pennsylvania, which has long advocated for solutions to increase access to health care for the most vulnerable, examined the medical records of nearly 150,000 patients. The patients were scheduled to receive outpatient primary care or specialist visit between March 16 and May 11, 2020, when the coronavirus emerged in the United States.

Because of government quarantine measures, more than half of these patients (54%) eventually received telemedicine care. Of them, 46% did so via video. The researchers found that, overall, patients over age 55 were 25% less likely to successfully participate in a telemedicine consultation than the average patient. Among those over 75, those odds were reduced by as much as 33%. In addition, Asian patients and non-English speaking patients were 31% and 16% less likely to participate in a telemedicine consultation than non-English speaking patients, respectively.

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Making Telemedicine accessible to all

“As we begin to establish new ways to care for our patients through telemedicine, it is important that we make this new format accessible to all,” said lead author Srinath Adusumalli, associate professor of cardiovascular medicine and associate director for medical information at the University of Pennsylvania Health System for Connected Health.

“We hope that regulators and payers will recognize the potential inequities that could arise from the policies they create, such as not reimbursing for phone visits, which could result in a lack of access to care for certain patient populations, especially those disproportionately affected by events like the Covid-19 crisis,” he said.

Early in the pandemic, the Centers for Medicare and Medicaid Services (CMS) had to relax some of these telehealth regulations. After looking at patients affected by this system, researchers found that disparities in teleconsultation were even greater than on a global scale. For example, people younger than 55 were at least 32% less likely to have a video visit, and those older than 75 were 51% less likely. Women, Latinos, and blacks were 8%, 10%, and 35% less likely to participate in a video visit than men and white patients, respectively. The trend was similar among lower-income households.

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For this reason, the researchers believe that SMCs should pay more attention to video consultations. While efforts have been made to facilitate telemedicine reimbursements through phone calls, more work needs to be done on other formats.

Adding an interpreter

“It is important that full parity of payment is maintained for all types of telemedicine visits by all insurance companies,” said Lauren Eberly, clinical research fellow in cardiovascular medicine and lead author of the study. Reducing reimbursement for telephone visits could disproportionately and unfairly hurt clinics and providers that serve minority and poor patients.

Since the beginning of the coronavirus epidemic, Penn Medicine has been working specifically on access to care for non-English speakers. “One specific issue that has already been addressed based on the results of this study is the integration of one-click interpreters for more than 40 video-based and more than 100 audio-based languages for inpatient and outpatient telemedicine care across our organization,” said Srinath Adusumalli.

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“We currently have more research underway to better characterize specific barriers for patients and providers,” continues Lauren Eberly. If we can understand these barriers, it could help develop strategies for telehealth adoption that benefit everyone.

References

Patient Characteristics Associated With Telemedicine Access for Primary and Specialty Ambulatory Care During the COVID-19 Pandemic

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