How telemedicine may exacerbate disparities in patients with limited English proficiency

Linggonegoro, Danny W.; Sanchez-Flores, Xavier; Huang, Jennifer T.

doi:10.1016/j.jaad.2021.02.032

Cited by 16 publications

(19 citation statements)

References 5 publications

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“…We urge providers to preidentify and address the barriers to adoption rather than confront them after implementation, to ensure a positive experience and service sustainability. 3,4 Extending Linggonegoro et al, 1 we identified the importance of social and cultural norms in the design of telemedicine solutions. 1,5 Sensitivity to these factors is particularly important when deploying teledermatology in heterogeneous populations.…”

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confidence: 75%

“…3,4 Extending Linggonegoro et al, 1 we identified the importance of social and cultural norms in the design of telemedicine solutions. 1,5 Sensitivity to these factors is particularly important when deploying teledermatology in heterogeneous populations. We also identified modifiable factors influencing uptake, such as the perceived quality and security of the technology and practical benefits, such as convenience and social distancing.…”

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confidence: 75%

“…2 We found that the willingness to use teledermatology was strongly correlated with barriers, such as the willingness to show images of the body on photo/video and financial costs. In this letter, we provide secondary analysis to build upon the discussion of barriers in the paper by Linggonegoro et al 1 In our data, females and ethnic Malays (who lean religiously conservative) and each individual's concerns over data security and privacy were associated with lower willingness to show body images over photo/video (Table I). These concerns were specific to ''zoom bombing'' and inappropriate recording.…”

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confidence: 89%

“…To the Editor: We read with interest the article by Linggonegoro et al, 1 which discussed limited English proficiency as a barrier toward uptake of teledermatology. We conducted a convergent parallel mixedmethod study to explore the willingness to use teledermatology during the COVID-19 pandemic.…”

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confidence: 99%

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Factors influencing willingness to pay and show images with teledermatology during the COVID19 pandemic

Ellie

Wei

Tan

et al. 2022

Journal of the American Academy of Dermatology

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confidence: 75%

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confidence: 75%

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confidence: 89%

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confidence: 99%

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Factors influencing willingness to pay and show images with teledermatology during the COVID19 pandemic

Ellie

Wei

Tan

et al. 2022

Journal of the American Academy of Dermatology

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“…Additionally, we observed high engagement with the HMP from both English and Spanish speakers. It is well-documented that non-English speaking populations are at risk for significant disparities in the delivery of telemedicine-based care [ 36 – 38 ]. This data demonstrates that telemedicine programs that are offered in multiple language and are designed with interpretive services as a centerpiece of their care can help overcome these disparities and achieve high engagement and satisfaction among non-English speakers.…”

Section: Discussionmentioning

confidence: 99%

Patient experience and healthcare utilization for a COVID-19 telemedicine home monitoring program offered in English and Spanish

et al. 2022

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Background Telemedicine is a vital component of the healthcare system’s response to COVID-19. In March of 2020, Providence health system rapidly implemented a telemedicine home monitoring program (HMP) for COVID-19 patients that included use of at-home pulse oximeters and thermometers and text-based surveys to monitor symptoms. By June 2020, Providence updated the HMP to be offered in Spanish. This program was implemented before COVID-19 testing was readily available and therefore was offered to all patients suspected of having COVID-19. This study examines engagement, experience, and utilization patterns for English and Spanish-speaking patients engaged in the COVID-19 HMP. Methods A retrospective review of program data was used to understand HMP patient engagement (responsiveness to three daily text to monitor symptoms), satisfaction with the program (likelihood to recommend the program) as well as comfort using home monitoring devices and comfort recovering from home. To understand impact on care for COVID-19 confirmed cases, we used electronic health records to measure patterns in healthcare use for COVID-19 positive HMP participants and non-HMP propensity weighted controls. All patients enrolled in the COVID-19 HMP from March–October 2020 were included in the study. Patients tested for COVID-19 during the time window and not enrolled in HMP were included in the propensity-weighted comparison group. Descriptive and regression analyses were performed overall and stratified by English and Spanish speakers. Results Of the 4,358 HMP participants, 75.5% identified as English speakers and 18.2% identified as Spanish speakers. There was high level of responsiveness to three daily text-based surveys monitoring symptoms engagement (>80%) and a high level of comfort using the home monitoring devices (thermometers and pulse oximeters) for English- and Spanish-speaking participants (97.3% and 99.6%, respectively). The majority of English (95.7%) and Spanish-speaking (100%) patients felt safe monitoring their condition from home and had high satisfaction with the HMP (76.5% and 83.6%, respectively). English and Spanish-speaking COVID-19 positive HMP participants had more outpatient and emergency departments (ED) encounters than non-participants 7 and 30 days after their positive test. Conclusion This widely implemented HMP provided participants with a sense of safety and satisfaction and its use was associated with more outpatient care and ED encounters. These outcomes were comparable across English and Spanish-speakers, highlighting the importance and potential impact of language-concordant telemedicine.

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Mode of delivery preference in prenatal genetic counseling between English‐ and Spanish‐speaking patients at two US medical institutions

Steyer

Hodges

Rouse

et al. 2023

Journal of Genetic Counseling

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Although Hispanic individuals are at an increased risk for various genetic conditions, they have lower uptake of genetic counseling and genetic testing. Virtual appointments have many advantages that may help Spanish‐speaking patients access genetic services more readily. Despite these benefits, there are limitations that may make them less attractive options for these individuals. This study aimed to determine if satisfaction with genetic counseling or mode of delivery preference differs between English‐ and Spanish‐speaking individuals who have had a virtual prenatal genetic counseling session. Participants were recruited from prenatal genetic counseling clinics at Indiana University Health and Eskenazi Hospital. A REDCap survey was sent to all eligible participants. Survey questions included mode of delivery preference for future genetic counseling sessions (virtual versus in‐person), the validated Genetic Counseling Satisfaction Scale, and questions inquiring about the importance of various factors affecting mode of delivery preference. Spanish‐speaking individuals preferred future visits to be in‐person, while English‐speaking individuals preferred future visits to be virtual (Fisher's exact p = 0.003). Several factors were associated with these preferences, including waiting time, ability to leave/take off work for an appointment, length of session, childcare arrangements, and people attending the appointment (all p < 0.05). Both language groups reported similar mean satisfaction with the genetic counseling provided during their previous virtual appointments (p = 0.51). This study found that certain aspects of virtual genetic counseling appointments make them less appealing to Spanish‐speaking individuals. Making virtual genetic counseling appointments more appealing while continuing to offer in‐person appointments may help Spanish‐speaking individuals receive necessary genetics services. Continued research into disparities and barriers to telemedicine for Spanish‐speaking patients is necessary to increase access to this service delivery model for genetic counseling.

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How telemedicine may exacerbate disparities in patients with limited English proficiency

Cited by 16 publications

References 5 publications

Factors influencing willingness to pay and show images with teledermatology during the COVID19 pandemic

Factors influencing willingness to pay and show images with teledermatology during the COVID19 pandemic

Patient experience and healthcare utilization for a COVID-19 telemedicine home monitoring program offered in English and Spanish

Mode of delivery preference in prenatal genetic counseling between English‐ and Spanish‐speaking patients at two US medical institutions

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