The pandemic has forced HCPs to rethink care delivery, dramatically expanding virtual care applications’ use. Digital technologies, in the form of web-based apps, wearable devices, home monitoring devices, personal health apps, personal health records, and remote medical visits, are gradually being implemented more and more by HCPs and are preferred by patients as a more convenient and efficient way of delivering and receiving care. Telehealth, offering numerous opportunities to the healthcare community, looks like it is actually “here to stay”.
The telehealth paradox. Does it improve patient access to healthcare?
However, this widespread use of telehealth applications led to a paradox; although digital technologies have been initially implemented in healthcare to improve patient access to care, ensuring health equity has been raised lately as one of the most significant concerns of telehealth use.
Telehealth digital equity barriers explained
When it comes to telehealth, certain factors impact the success or not of the use and adoption of its services. Below, we discuss how the patients’ low socioeconomic status, elderly age, existing disability, low language literacy, and low digital literacy hinder telehealth effectiveness.
- Patients’ socioeconomic status
A 2021 report by Monica Anderson and Madhumitha Kumar showcased that 24% of lower-income Americans who participated in the research reported that they don’t own a smartphone. In addition, 43% of them lack home broadband services, and 41% do not have a desktop or laptop computer. Technology access and language and digital challenges impact racial and ethnic minorities the most, discouraging them from using and benefiting from telehealth applications.
- Patients’ age
Psychological, functional (hearing, vision challenges, cognitive impairment, etc.), or educational limitations(low skill or comfort level with technology), may impact older adults’ ability to participate actively in the digital era. The study of G. Choi et al. (2013) showcased that a person’s age is “inversely associated with Internet use, with lower usage rates among those with more advanced age”. According to the study, 34% of the younger group (under 60 years) and 17% of the older group (60 years and older) have relatively low internet usage rates.
- Patients’ disabilities
People with certain physical limitations or learning disabilities may experience digital literacy challenges, impacting their ability to access or use telehealth technologies.
- Patients’ language barriers
Digital technologies’ use offers require a certain level of oral and written language understanding, with many patients facing communication hurdles affecting their relationships with the caregiver.
- Patients’ digital literacy level
A certain level of digital literacy is required from the patient’s side to successfully run a telehealth call, such as connecting to the internet, navigating within a digital platform, the email and web browser, downloading applications, using the computer camera, microphone, and speakers, etc.
5 + 1 practices to promote equitable access to telehealth
Addressing telehealth disparities and ensuring access to those who need it the most has recently gained attention. We expect that the following practices will contribute to patient inclusion and leverage telehealth applications.
1. Adding time buffers between telehealth consultations
Some patients may need additional time to connect to the appointments or extra time during the visit due to specific digital or language challenges. Therefore, healthcare professionals could allow a time buffer within these visits to help their patients feel more comfortable and less pressured during the process.
2. Providing customized material accessible to all
Materials should be available in different languages and formats; images are also important for certain patient populations who experience literacy hurdles.
3. Addressing language challenges
Screen readers or closed captioning options could help patients with language challenges.
4. Taking into consideration patients’ preferences beforehand
Asking patients to fill in forms prior to the visit, in which they could state their technology or language preferences for the upcoming meeting, would enhance their experience.
5. Gathering patient feedback to measure patient satisfaction
Post-visit surveys could provide the medical team with direct patient feedback and help to improve telehealth services.
6. Developing versatile applications that function well regardless of the device
Digital applications usually require the user to have the latest devices and upgrades, something that could be an important connectivity barrier for underserved communities or those who struggle with digital literacy, as reported by an expert during a roundtable held by the National Committee for Quality Assurance (NCQA) in the US. As a proposed solution, the experts highlighted the need to leverage technologies with low barriers to entry for use in telehealth services.
Taking telehealth to the next level means correcting access inequities.
Lack of health equity is an important issue that could lead to severe consequences for certain patient populations, such as higher rates of disease or higher mortality rates. The healthcare community should now actively focus on reaching these underserved communities, identifying the factors affecting their access to telehealth, and looking for solutions to promote equitable access. We should all ensure that telehealth is “here to stay” to enable access to all – and not to increase healthcare inequities further.
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Sources:
https://telehealth.hhs.gov/providers/health-equity-in-telehealth/
https://www.ncqa.org/wp-content/uploads/2022/05/NCQA-TelehealthAndEquity-Whitepaper-Draft5.pdf
https://ajp.psychiatryonline.org/doi/10.1176/appi.ajp.2020.20060867
https://www.ncbi.nlm.nih.gov/pmc/articles/PMC3650931/