Association of Health Literacy and Area Deprivation With Initiation and Completion of Telehealth Visits in Adult Medicine Clinics Across a Large Health Care System

Brown, Sarah H.; Griffith, Michelle L.; Kripalani, Sunil; Horst, Sara

doi:10.1001/jamanetworkopen.2022.23571

Cited by 18 publications

(7 citation statements)

References 6 publications

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“…Our results showed that, Chinese patients were mostly limited to shallow IMS (e.g., minor disease, and routine visit) mainly provided by private platform and Internet hospital, regardless of the data from the provincial eld survey or the national online survey. However, the respondents with superior demographic (e.g., aged below 60 years old) and socio-economic factors (e.g., higher annual disposable income) from the national online survey were more likely to be deeply involved in IMSU (e.g., mental diseases: 374 times with 10.44%; telediagnosis: 378 times with 8.23%), which were consistent with previous studies [30][31][32][33][34]. Prior research has also indicated that the patterns of IMSU would be deepen in the patients with a chronic condition, nevertheless, in this study, patients suffering chronic diseases were less accessed to IMSU that those not suffering (35.59% vs. 40.56%) based on the provincial eld survey data, and patients suffering chronic diseases accessed to IMSU at a high frequency was lower than that at a low frequency (29.86% vs. 34.45%) based on the national online survey data [13,20,32,[35][36][37][38][39].…”

Section: Discussionsupporting

confidence: 89%

Disparities in Status, Patterns, and Preferences of Internet Medical Services Utilization for Patients During the Post-COVID-19 Pandemic Period in China: Evidence from Provincial Field and National Online Surveys

Sun,

Chen,

Qian

2024

Preprint

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Background Disparities in Internet medical services utilization for patients marginalize vulnerable groups from digital health benefits. However, these disparities were not well understood during the post COVID pandemic period in China.Objective This study aimed to identify the disparities which limit Internet medical services utilization for Chinese adult patients, then provide key reference points for digital health-related policies.Methods Data were obtained from the 2023 provincial field survey that included Jiangsu adult outpatients, and the 2024 national online survey that included Chinese adults with outpatient records in the past 3 months. A descriptive and comparative analysis for status, patterns, and preferences of Internet medical services utilization. Binary logistic regression model assessed patient characteristics associated with the status of Internet medical services utilization.Results Of 2,011 patients in the Jiangsu field survey, 39.43% reported using Internet medical services at least once in previous 12 months. The status of Internet medical services utilization was associated with partial patient characteristics significantly. For example, patients aged below 60 years were more likely to access Internet medical services than aged over 60 years (odds ratio [OR] 1.54, 95% CI 1.07–2.21, P = .02). For the patterns, patients were trapped in shallow Internet medical services (e.g., minor disease was the most primary reason with 55.93%). Vulnerable patients such as geriatrics aged over 60 years without medical insurance were less likely to prefer higher-price internet medical services (median score 1 point). Of 1,611 patients in the national online survey, all patients reported accessing Internet medical services in previous 12 months. The status of Internet medical services utilization was partial associated with patient characteristics significantly. For instance, patients in very-unhealth status were more likely to access Internet medical services than in health status (OR 4.19, 95% CI 1.36–12.95, P = .01). For the patterns, patients were trapped in shallow Internet medical services (e.g., minor disease was one domain primary reason with 28.38%). Uninsured patients aged below 60 years were less likely to prefer higher-price Internet medical services (median score 2 point).Conclusions Disparities maintained in status, patterns, and preferences of Internet medical services utilization among Chinese adult patients after the COVID-19 pandemic. More pro-vulnerable patients policies may be warranted for narrowing Internet medical services utilization disparities to ensure digital health equity in China.

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Section: Discussionsupporting

confidence: 89%

Disparities in Status, Patterns, and Preferences of Internet Medical Services Utilization for Patients During the Post-COVID-19 Pandemic Period in China: Evidence from Provincial Field and National Online Surveys

Sun,

Chen,

Qian

2024

Preprint

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“…Several papers show that the educational level of an individual and digital literacy play a vital role in the adoption of telehealth services, in contrast to the results of this study [27,51,52]. In particular, racial minorities, older adults, and people with lower educational levels are not likely to engage in web-based patient portals despite having a stable internet connection [53][54][55]. Another interesting study compared whether an individual's educational level or SES had a significant influence on telehealth use and adoption.…”

Section: Comparison With Existing Researchcontrasting

confidence: 80%

Social Determinants of Health and Patients’ Technology Acceptance of Telehealth During the COVID-19 Pandemic: Pilot Survey

Anil Kumar Vaidhyam,

Huang

2023

JMIR Hum Factors

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Background Telehealth has been widely adopted by patients during the COVID-19 pandemic. Many social determinants of health influence the adoption. Objective This pilot study aimed to understand the social determinants of patients’ adoption of telehealth in the context of the pandemic. Methods A survey methodology was used to capture data from 215 participants using Amazon Mechanical Turk. The study was guided by the technology acceptance model and the social determinants of health framework. The questionnaire included technology acceptance model variables (eg, perceived usefulness [PU] and perceived ease of use [PEOU]), social determinants (eg, access to health care, socioeconomic status, education, and health literacy), and demographic information (eg, age, sex, race, and ethnicity). A series of ordinary least squares regressions were conducted to analyze the data using SPSS Statistics (IBM Corp). Results The results showed that social determinant factors—safe neighborhood and built environment (P=.01) and economic stability (P=.05)—are predictors of the PEOU of telehealth adoption at a statistically significant or marginally statistically significant level. Furthermore, a moderated mediation model (PROCESS model 85) was used to analyze the effects of COVID-19 on the neighborhood, built environment, and economic stability. PEOU and PU significantly positively affected users’ intention to use technology for both variables. Conclusions This study draws attention to 2 research frameworks that address unequal access to health technologies. It also adds empirical evidence to telehealth research on the adoption of patient technology. Finally, regarding practical implications, this study will provide government agencies, health care organizations, and health care companies with a better perspective of patients’ digital health use. This will further guide them in designing better technology by considering factors such as social determinants of health.

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“…Similar to another study [ 26 ], patients from disadvantaged areas (patients in ADI quartile two, three, or four) were more likely to rely on phone consultations for telemedicine visits compared to patients from the least disadvantaged category (ADI quartile one). Despite efforts to expand telemedicine services in the health system, the utilization of video visits did not increase during the study period, even among individuals from the less disadvantaged neighborhoods (ADI quartile one).…”

Section: Discussionsupporting

confidence: 68%

Telemedicine and health disparities: Association between the area deprivation index and primary care telemedicine utilization during the COVID-19 pandemic

Ostovari¹,

Zhang²,

Patel³

et al. 2023

J. Clin. Trans. Sci.

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Introduction: The rapid implementation of telemedicine during the COVID-19 pandemic may have exacerbated the existing health disparities. This study investigated the association between the area deprivation index (ADI), which serves as a measure of socioeconomic deprivation within a geographic area, and the utilization of telemedicine in primary care. Methods: The study data source was electronic health records. The study population consisted of patients with at least one primary care visit between March 2020 and December 2021. The primary outcome of interest was the visit modality (office, phone, and video). The exposure of interest was the ADI score grouped into quartiles (one to four, with one being the least deprived). The confounders included patient sociodemographic characteristics (e.g., age, gender, race, ethnicity, insurance coverage, marital status). We utilized generalized estimating equations to compare the utilization of telemedicine visits with office visits, as well as phone visits with video visits. Results: The study population included 41,583 patients with 127,165 office visits, 39,484 phone visits, and 20,268 video visits. Compared to patients in less disadvantaged neighborhoods (ADI quartile = one), patients in more disadvantaged neighborhoods (ADI = two, three, or four) had higher odds of using phone visits vs office visits, lower odds of using video visits vs office visits, and higher odds of using phone visits vs video visits. Conclusions: Patients who resided in socioeconomically disadvantaged neighborhoods mainly relied on phone consultations for telemedicine visits with their primary care provider. Patient-level interventions are essential for achieving equitable access to digital healthcare, particularly for low-income individuals.

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Association of Health Literacy and Area Deprivation With Initiation and Completion of Telehealth Visits in Adult Medicine Clinics Across a Large Health Care System

Cited by 18 publications

References 6 publications

Disparities in Status, Patterns, and Preferences of Internet Medical Services Utilization for Patients During the Post-COVID-19 Pandemic Period in China: Evidence from Provincial Field and National Online Surveys

Disparities in Status, Patterns, and Preferences of Internet Medical Services Utilization for Patients During the Post-COVID-19 Pandemic Period in China: Evidence from Provincial Field and National Online Surveys

Social Determinants of Health and Patients’ Technology Acceptance of Telehealth During the COVID-19 Pandemic: Pilot Survey

Telemedicine and health disparities: Association between the area deprivation index and primary care telemedicine utilization during the COVID-19 pandemic

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