Pre-existing Disparities and Potential Implications for the Rapid Expansion of Telemedicine in Response to the Coronavirus Disease 2019 Pandemic

Poeran, Jashvant; Cho, Logan D.; Wilson, Laird; Zhong, Haoyan; Mazumdar, Madhu; Liu, Jiabin; Memtsoudis, Stavros G.

doi:10.1097/mlr.0000000000001585

Cited by 48 publications

(69 citation statements)

References 19 publications

Supporting

Mentioning

Contrasting

Order By: Relevance

“…There is limited research that explicitly compares telemedicine adoption among Medicaid enrollees relative to non-Medicaid populations, though at least one study finds between 1.5 and 2 times as much adoption among higher income households relative to lower income households. 22 Fifth, since we do not have data beyond the end of July of 2020, we are unable to make statements regarding the trajectory of telemedicine usage between that month and the time of writing. Sixth, while our analysis will capture the majority of claims for dual-eligible enrollees, we may miss a small percentage of claims that were not sent to Medicaid for adjudication.…”

Section: Discussionmentioning

confidence: 99%

“…21 However, there is little research on differential uptake of telemedicine services by location or mode of delivery, though there are concerns that telemedicine has the potential to exacerbate disparities in health care if a lack of broadband access (ie, the "digital divide") makes it difficult for those in rural areas to access telemedicine services. 22,23 This study uses administrative data comprising the universe of Medicaid claims for the State of Florida over the period January 2019 -July 2020 to examine variation over time in claims for different services before and after the expanded reimbursement and utilization of telemedicine during the COVID-19 pandemic. We investigate how the substitution towards telemedicine visits (overall and by mode of visit) varied across subgroups of Medicaid beneficiaries, including age, health status, prior health care use, and geography.…”

mentioning

confidence: 99%

See 1 more Smart Citation

Using Administrative Data to Examine Telemedicine Usage Among Medicaid Beneficiaries During the Coronavirus Disease 2019 Pandemic

2022

View full text Add to dashboard Cite

Background: The coronavirus disease 2019 (COVID-19) pandemic necessitated the replacement of in-person physician consultations with telemedicine. During the pandemic, Medicaid covered the cost of telemedicine visits. Objectives: The aim was to measure the adoption of telemedicine during the pandemic. We focus on key patient subgroups including those with chronic conditions, those living in urban versus rural areas, and different age groups. Methods: This study examined the universe of claims made by Florida Medicaid beneficiaries (n=2.4 million) between January 2019 and July 2020. Outpatient visits were identified as in-person or telemedicine. Telemedicine visits were classified into audio-visual or audio-only visits. Results: We find that telemedicine offsets much of the decline in in-person outpatient visits among Florida’s Medicaid enrollees, however, uptake differs by enrollee type. High utilizers of care and beneficiaries with chronic conditions were significantly more likely to use telemedicine, while enrollees living in rural areas and health professional shortage areas were moderately less likely to use telemedicine. Elderly Medicaid recipients (dual-eligibles) used audio-only telemedicine visits at higher rates than other age groups, and the demand for these consultations is more persistent. Conclusions: Telemedicine offset the decline in health care utilization among Florida’s Medicaid-enrolled population during the novel coronavirus pandemic, with particularly high uptake among those with prior histories of high utilization. Audio-only visits are a potentially important method of delivery for the oldest Medicaid beneficiaries.

show abstract

Section: Discussionmentioning

confidence: 99%

mentioning

confidence: 99%

Using Administrative Data to Examine Telemedicine Usage Among Medicaid Beneficiaries During the Coronavirus Disease 2019 Pandemic

2022

View full text Add to dashboard Cite

show abstract

“…Twenty-one studies were based in the USA [ 31 – 51 ], three in Australia [ 52 – 54 ], two in Canada [ 55 , 56 ], and one each in Chile [ 57 ], Italy [ 58 ] and Scotland [ 59 ]. One based their research in primary and secondary care settings [ 37 ], one in primary and tertiary care [ 44 ], eleven solely in secondary care [ 39 , 41 , 45 , 46 , 51 , 52 , 55 – 59 ] and sixteen in tertiary care [ 31 – 36 , 38 , 40 , 42 , 43 , 47 – 50 , 53 , 54 ]. The research was specifically set in the context of COVID-19 in twenty-one studies [ 32 , 33 , 35 – 39 , 41 , 43 – 51 , 54 , 56 – 58 ].…”

Section: Resultsmentioning

confidence: 99%

“…Twenty-two studies considered a single clinical specialty; the remaining seven included patients with any condition or those with chronic conditions in general. A retrospective cohort study was the most frequent study design [ 31 , 36 – 41 , 44 , 45 , 47 , 49 , 55 ]. All but one study reported data on participants’ gender [ 49 ], with twenty reporting ethnicity data [ 31 – 33 , 35 – 42 , 44 – 46 , 48 – 51 , 53 , 55 ] and fifteen mean age [ 31 – 35 , 39 , 42 , 46 , 48 , 51 – 54 , 57 , 58 ] ( Table 2 ).…”

Section: Resultsmentioning

confidence: 99%

Real-time remote outpatient consultations in secondary and tertiary care: A systematic review of inequalities in invitation and uptake

Jones

Damery²,

Phillips³

et al. 2022

PLoS ONE

View full text Add to dashboard Cite

Background Health policies in most high income countries increasingly recommend provision of routine outpatient care via remote (video and/or telephone) appointments, especially due to the pandemic. This is thought to improve access to care and promote efficiency within resource-constrained health services. There is limited evidence about the impact on existing inequalities in the invitation and uptake of health services when remote outpatient care is offered. Aim To systematically review the evidence on the offer and/or uptake of real-time remote outpatient consultations in secondary and tertiary care, assessed according to key sociodemographic characteristics. Methods Seven electronic bibliographic databases were searched for studies reporting the proportion of patients with key characteristics (following PROGRESS Plus criteria) who were offered and/or accepted real-time remote outpatient consultation for any chronic condition. Comparison groups included usual care (face-to-face), another intervention, or offer/uptake within a comparable time period. Study processes were undertaken in duplicate. Data are reported narratively. Results Twenty-nine studies were included. Uptake of video consultations ranged from 5% to 78% and telephone consultations from 12% to 78%. Patients aged over 65, with lower educational attainment, on lower household incomes and without English as a first language were least likely to have a remote consultation. Females were generally more likely to have remote consultations than males. Non-white ethnicities were less likely to use remote consultations but where they did, were significantly more likely to choose telephone over video appointments (p<0.001). Conclusions Offering remote consultations may perpetuate or exacerbate existing health inequalities in access to healthcare. More research is needed on current health disparities by sociodemographic characteristics and to explore what works well for different patient groups and why so that processes can be designed to ameliorate these health disparities. Trial registration PROSPERO registration no: CRD42021241791.

show abstract

“…The COVID-19 situation has propelled the acceleration of the digitalization process, which is strengthening the health system in Morocco by making digital health accessible throughout the entire country and the national health system. Regional, rural/urban, and within major cities socioeconomic and technological disparities create barriers to equal access to telemedicine by clinicians and patients (51). These impediments may exacerbate health inequities and jeopardize global efforts to reduce COVID-19's impact (52,53).…”

Section: Discussionmentioning

confidence: 99%

Moroccan Digital Health Response to the COVID-19 Crisis

Dehbi

Sedrati

Chaqsare

et al. 2021

Front. Public Health

View full text Add to dashboard Cite

The COVID-19 pandemic and the draconian measures applied to limit its spread have accelerated the process of digitalizing many activities, including those within the health sector. In Morocco, a developing country in northern Africa, digital health has been deployed extensively, and in a remarkable way, to support the management of the current health crisis. Morocco is taking significant measures to become a key player in the process of achieving Sustainable Development Goals (SDG) goal 3. The government has comprehensively integrated digital technology throughout its coordinated containment and mitigation processes. These processes encompass testing and diagnostics; virus genomic surveillance; telecare of suspected and chronic patients; COVID-19 patient contact tracing and tracking; a laboratory information system for medical material dispatching, biological sample collection, and data processing nationwide; and smart vaccination management. Moreover, the pace of amending legislation for enabling efficient telemedicine practice has been achieved at a record-breaking. The successful implementation of all of these digital health strategies testify to the effectiveness of digitalization for managing the health aspects of the pandemic and for the future development of health systems in Morocco and in the African continent, where digital health and telemedicine is set to become the cornerstone of medical practice.

show abstract

Pre-existing Disparities and Potential Implications for the Rapid Expansion of Telemedicine in Response to the Coronavirus Disease 2019 Pandemic

Cited by 48 publications

References 19 publications

Using Administrative Data to Examine Telemedicine Usage Among Medicaid Beneficiaries During the Coronavirus Disease 2019 Pandemic

Using Administrative Data to Examine Telemedicine Usage Among Medicaid Beneficiaries During the Coronavirus Disease 2019 Pandemic

Real-time remote outpatient consultations in secondary and tertiary care: A systematic review of inequalities in invitation and uptake

Moroccan Digital Health Response to the COVID-19 Crisis

Contact Info

Product

Resources

About