Access to technology to support telehealth in areas without specialty care for liver disease

Abstract

Background and Aims: Telehealth may be a successful strategy to increase access to specialty care for liver disease, but whether the areas with low access to care and a high burden of liver‐related mortality have the necessary technology access to support a video‐based telehealth strategy to expand access to care is unknown. Approach and Results: Access to liver disease specialty care was defined at the county level as <160.9 km (100 miles) from a liver transplant (LT) center or presence of local gastroenterology (GI). Liver‐related mortality rates were compared by access to care, and access to technology was compared by degree of access to care and burden of liver‐related mortality. Counties with low access to liver disease specialty care had higher rates of mortality from liver disease, and this was highest in areas both >160.9 km from an LT center and without local GI. These counties were more rural, had higher poverty, and had decreased access to devices and internet at broadband speeds. Technology access was lowest in areas with low access to care and the highest burden of liver‐related mortality. Conclusions: Areas with poor access to liver disease specialty care have a greater burden of liver‐related mortality, and many of their residents lack access to technology. Therefore, a telehealth strategy based solely on patient device ownership and internet access will exclude a large proportion of individuals in the areas of highest need. Further work should be done at the local and state levels to design optimal strategies to reach their populations of need.

Impact of internet plus health education on urinary stoma caregivers in coping with care burden and stress in the era of COVID-19

“…The present substantiated that IPHE could enhance the caregivers’ stoma care ability. The IPHE described herein harnesses language, audio and video of modern multi-media communications technologies to help the caregivers in all aspects and learn about their main and difficult points in postoperative urinary stoma care ( Henson et al, 2022 ). In addition, this IPHE mode is appropriate to our current pace of life and work and helps the caregivers learn and master the main nursing points through fragmented time to reduce the tiredness of the caregivers during the learning process ( Baumeister et al, 2022 ; Eke et al, 2022 ).…”

Geographic disparities in access to liver transplantation

“…[123] To achieve its full potential, telehealth must first overcome the "digital divide" [124] that exists, with patients living in low SES communities being less likely to access high-quality internet, which is a necessary tool for telehealth. [125] Studies showing that patients from more deprived communities are less likely to receive LT, [83] with only a quarter getting waitlisted for LT, [67] suggest that neighborhood deprivation could be used as a measure of SES to identify patients at increased risk of dropping out during LT evaluation. One potential solution would be incorporating neighborhood deprivation indices in LT evaluation, allowing transplant centers to identify patients who might benefit from additional support in the form of social workers, case managers, and patient navigators.…”

“…Telehealth is another tool to address the lack of transportation and has been associated with decreased time from referral to evaluation and waitlisting 123 . To achieve its full potential, telehealth must first overcome the “digital divide” 124 that exists, with patients living in low SES communities being less likely to access high-quality internet, which is a necessary tool for telehealth 125 …”

The digital determinants of liver disease

“…However, in this month's issue of Hepatology , Henson and colleagues6 report dismaying data refuting the promise of telehealth to improve access and narrow disparities in liver disease. The authors evaluated county‐level associations among liver‐related mortality, broadband availability, and access to a gastroenterologist/liver transplant center.…”

“…Given this rapid uptake, telehealth has been identified as an important tool for treating patients with end-stage liver disease that may improve patient access and allow for more equitable care delivery. [5] However, in this month's issue of Hepatology, Henson and colleagues [6] report dismaying data refuting the promise of telehealth to improve access and narrow disparities in liver disease. The authors evaluated county-level associations among liver-related mortality, broadband availability, and access to a gastroenterologist/liver transplant center.…”