Patient interest in and barriers to telemedicine video visits in a multilingual urban safety-net system

Abstract

Objective: To determine interest in and barriers to video visits in safety-net patients with diverse age, racial/ethnic, or linguistic background. Materials and methods: We surveyed patients in an urban safety-net system to assess: interest in video visits; ability to successfully complete test video visits; and barriers to successful completion of test video visits. Results: Among 202 participants, of which 177 (87.6%) were persons of color and 113 (55.9%) preferred non-English languages, 132 (65.3%) were interested in and 109 (54.0%) successfully completed a test video visit. Younger age, non-English preference, and prior smartphone application use were associated with interest. Over half (n=112) reported barriers to video visits; Internet/data access was the most common barrier (n=50, 24.8%). Conclusion: Safety-net patients are interested in video visits and able to successfully complete test visits. Internet or mobile data access is a common barrier in even urban safety-net settings and may impact equitable telemedicine access.

Ensuring Equitable Implementation of Telemedicine in Perinatal Care

“…Our study among patients in the safety-net system revealed that a majority of prenatal and postpartum individuals were interested in video visits and had no barriers to engaging in a trial video visit. 19 More non–English speakers preferred to have a video rather than a phone visit (87% vs 60% of English speakers), consistent with prior studies that have shown communication barriers are more easily overcome with a video aid compared with telephone. 27 Importantly, those who lacked digital literacy , defined as being unable to use their device or connect to the internet and complete a trial visit, were more likely to identify as Black or Latina and be non–English speaking, consistent with prior studies among nonpregnant populations.…”

“…18 In response, we conducted a phone survey with 202 San Francisco General Hospital patients whose in-person visits had been converted to phone visits because of COVID-19 concerns to explore interest in and barriers around video visits. 19 Among the 92 patients scheduled for pregnancy-related visits, 78% were interested in having a video visit, 86% of those interested had a video-enabled device and sufficient internet access, and 69% were able to download the necessary device application and complete a trial video visit during the survey call.…”

Patient Characteristics and Subsequent Health Care Use by Location of SARS-CoV-2 Testing Initiation in a Safety-Net Health System

“…Nonetheless, our findings highlight demographic and clinical differences in health care use for SARS-CoV-2 testing across all care delivery settings, which can strategically inform outreach efforts for distinct populations. Without structural reforms, rapid implementation of telehealth and other new services may exacerbate inequities in access to care, 2 , 3 , 4 , 5 particularly if these investments come at the expense of other care sites.…”

“…These racial/ ethnic and language inequities in entry location intensity may be explained by structural barriers to timely testing access, delayed care seeking, and increased comorbidity burden among patients with acute presentations, as well as clinician-and practice-level variation in telehealth use. [2][3][4][5][6] Testing initiated via telehealth and outpatient encounters was associated with lower rates of subsequent inpatient and intensive care unit care than testing initiated in more intensive settings.…”

The COVID‐19 pandemic and reproductive genetic counseling: Changes in access and service delivery at an academic medical center in the United States

“…In the pre‐COVID‐19 era, telehealth was not widely adopted as a means of clinical patient care (Greenberg et al., 2020 ; NSGC Professional Status Survey: Executive Summary, 2020 ; Wootton, 2012 ). Data suggest that telehealth increases patient access to providers and has high patient satisfaction (Abrams & Geier, 2006 ; Greenberg et al., 2020 ), yet there are known barriers to implementation, such as technology appropriation, billing and reimbursement, and patient and provider resistance (Cohen et al., 2016 ; Khoong et al., 2021 ; Scott Kruse et al., 2018 ; Shivkumar et al., 2021 ; Wang et al., 2021 ). Genetic counselors were early adopters of telehealth, as their services are easily adapted for telecommunication (NSGC Professional Status Survey: Executive Summary, 2020 ; Stoll et al, 2018 ; Zierhut et al, 2018 ).…”