Achieving Health Equity: Examining Telehealth in Response to a Pandemic

Smith, Shelly; Raskin, Sarah

doi:10.1016/j.nurpra.2020.10.001

Cited by 12 publications

(12 citation statements)

References 14 publications

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“…9,24,25 Studies found that mental health and private facilities were more equipped to handle the increase in demand for telehealth than primary care clinics and public facilities but still struggled with addressing the disparities within vulnerable populations. 9,24 Our findings were consistent with the literature in that social determinants of health, such as being uninsured or underinsured, limited broadband coverage, and poor housing conditions, 26 constitute important barriers to telemedicine use. 3,27 These relationships hold true even among people who already delayed or forgone care due to the COVID-19 pandemic.…”

Section: Discussionsupporting

confidence: 89%

Disparities in telehealth utilization during the COVID-19 pandemic: Findings from a nationally representative survey in the United States

et al. 2021

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Telehealth is an important source of health care during the COVID-19 pandemic. Evidence is scarce regarding disparities in telehealth utilization in the United States. We aimed to investigate the prevalence and factors associated with telehealth utilization among US adults. Our data came from the Health, Ethnicity, and Pandemic Study, a nationally representative survey conducted in October 2020, with 2554 adults ≥ 18 and an oversample of racial/ethnic minorities. Telehealth utilization was measured as self-reported teleconsultation with providers via email, text message, phone, video, and remote patient monitoring during the pandemic. Logistic regressions were performed to examine the association between telehealth use and factors at the individual, household, and community levels. Overall, 43% of the sample reported having used telehealth, representing 114.5 million adults in the nation. East and Southeast Asians used telehealth less than non-Hispanic Whites (OR = 0.5, 95% CI: 0.3–0.8). Being uninsured (compared with private insurance: OR = 0.4, 95% CI: 0.2–0.8), and those with limited broadband coverage in the community (OR = 0.5, 95% CI: 0.3–0.8) were less likely to use telehealth. There is a need to develop and implement more equitable policies and interventions at both the individual and community levels to improve access to telehealth services and reduce related disparities.

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Section: Discussionsupporting

confidence: 89%

Disparities in telehealth utilization during the COVID-19 pandemic: Findings from a nationally representative survey in the United States

et al. 2021

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“…Payment parity, which requires insurers to reimburse providers at the same rate as in-person services, is viewed by many stakeholders, including small clinics and CHCs, as an incentive to telehealth utilization. 4–6 …”

Section: Introductionmentioning

confidence: 99%

Association between state payment parity policies and telehealth usage at community health centers during COVID-19

Erikson

Herring

Park

et al. 2022

Journal of the American Medical Informatics Association

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Objective We study the association between payment parity policies and telehealth utilization at community health centers (CHCs) before, during, and after the onset of the pandemic. Materials and Methods We use aggregated, de-identified data from FAIR Health for privately insured patients at CHC sites. Descriptive statistics and time trends are calculated. Logistic regression models were used to quantify the factors associated with telehealth utilization for each of our time periods: 1) pre-pandemic (March-June 2019), 2) immediate pandemic response (March-June 2020), and 3) sustained pandemic response (March-June 2021). Results Telehealth usage rates at CHC sites surged to approximately 61% in April 2020. By April 2021, only 29% of CHC sites in states without payment parity policies used telehealth versus 42% in states without. Controlling for other characteristics, we find that CHC sites in states with payment parity were more likely to utilize telehealth one year after the onset of the pandemic (OR:1.740, p<0.001) than states without, but did not find this association in 2019 or 2020. Discussion The public health emergency drove widespread use of telehealth, making the virtual care environment inherently different in 2021 than in 2019. Due to the unique fiscal constraints facing CHCs, the financial sustainability of telehealth may be highly relevant to the relationship between telehealth utilization and payment parity we find in this paper. Conclusion Supportive payment policy and continued investments in broadband availability in rural and undeserved communities should enable CHCs to offer telehealth services to populations in these areas.

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“…However, prior to the pandemic, racial disparities persisted among the prevalence of patients with ASD and CP (Nevison & Zahorodny, 2019; Van Naarden Braun et al, 2016). Disparities in health care utilization in telehealth may further compound health inequity in the future among those groups, particularly for members of racial/ethnic minorities living in rural communities (Probst et al, 2004; Smith & Raskin, 2021). Ensuring access for all patients is vital for health equity, and more research is needed to understand how best to support patients from diverse backgrounds.…”

Section: Discussionmentioning

confidence: 99%

Pediatric Outpatient Occupational Therapy: Transitioning From In-Person Services to Telehealth

Tanner

O’Rourke

et al. 2023

OTJR: Occupational Therapy Journal of Research

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The COVID-19 pandemic necessitated rapid adoption of telehealth for outpatient pediatric occupational therapy practice. The dose of therapy may have varied across diagnostic and geographical groups despite efforts to ensure access for all patients. The objective of the study was to describe the visit length of outpatient pediatric occupational therapy practice for three diagnostic groups at one institution both during and prior to the COVID-19 pandemic. Retrospective review of electronic health records for two time periods using both practitioner-entered and telecommunications data. Data were analyzed using descriptive statistics and generalized linear mixed model. Prior to the pandemic, average treatment length did not vary by primary diagnosis. During the pandemic, average visit length varied by primary diagnosis, with feeding disorder (FD) visits significantly shorter than cerebral palsy (CP) and autism spectrum disorder (ASD) visits. During the pandemic, visit length was associated with rurality for the whole sample and for patients with ASD and CP, but not FD. Patients with FD may have been seen for shorter durations during telehealth visits. The technology gap may affect services for patients living in rural communities.

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Achieving Health Equity: Examining Telehealth in Response to a Pandemic

Cited by 12 publications

References 14 publications

Disparities in telehealth utilization during the COVID-19 pandemic: Findings from a nationally representative survey in the United States

Disparities in telehealth utilization during the COVID-19 pandemic: Findings from a nationally representative survey in the United States

Association between state payment parity policies and telehealth usage at community health centers during COVID-19

Pediatric Outpatient Occupational Therapy: Transitioning From In-Person Services to Telehealth

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