Rapid Transition to Telehealth and the Digital Divide: Implications for Primary Care Access and Equity in a Post‐COVID Era

Abstract

Policy Points Telehealth has many potential advantages during an infectious disease outbreak such as the COVID‐19 pandemic, and the COVID‐19 pandemic has accelerated the shift to telehealth as a prominent care delivery mode. Not all health care providers and patients are equally ready to take part in the telehealth revolution, which raises concerns for health equity during and after the COVID‐19 pandemic. Without proactive efforts to address both patient‐ and provider‐related digital barriers associated with socioeconomic status, the wide‐scale implementation of telehealth amid COVID‐19 may reinforce disparities in health access in already marginalized and underserved communities. To ensure greater telehealth equity, policy changes should address barriers faced overwhelmingly by marginalized patient populations and those who serve them. Context The COVID‐19 pandemic has catalyzed fundamental shifts across the US health care delivery system, including a rapid transition to telehealth. Telehealth has many potential advantages, including maintaining critical access to care while keeping both patients and providers safe from unnecessary exposure to the coronavirus. However, not all health care providers and patients are equally ready to take part in this digital revolution, which raises concerns for health equity during and after the COVID‐19 pandemic. Methods The study analyzed data about small primary care practices’ telehealth use and barriers to telehealth use collected from rapid‐response surveys administered by the New York City Department of Health and Mental Hygiene's Bureau of Equitable Health Systems and New York University from mid‐April through mid‐June 2020 as part of the city's efforts to understand how primary care practices were responding to the COVID‐19 pandemic following New York State's stay‐at‐home order on March 22. We focused on small primary care practices because they represent 40% of primary care providers and are disproportionately located in low‐income, minority or immigrant areas that were more severely impacted by COVID‐19. To examine whether telehealth use and barriers differed based on the socioeconomic characteristics of the communities served by these practices, we used the Centers for Disease Control and Prevention Social Vulnerability Index (SVI) to stratify respondents as being in high‐SVI or low‐SVI areas. We then characterized respondents’ telehealth use and barriers to adoption by using means and proportions with 95% confidence intervals. In addition to a primary analysis using pooled data across the five waves of the survey, we performed sensitivity analyses using data from respondents who only took one survey, first wave only, and the last two waves only. Findings While all providers rapidly shifted to telehealth, there were differences based on community characteristics in...

Benefits and Challenges of Using Virtual Primary Care During the COVID-19 Pandemic: From Key Lessons to a Framework for Implementation

“…In line with previous literature, our results demonstrate the ability of remote care to overcome barriers for those who have physical limitations to attend a face-to-face meeting, but also highlight their potential to entrench existing inequities in access to care [50,51]. Published evidence shows that the transition to virtual primary care did not unfold in the same manner across communities [52]. Proactive efforts are therefore needed to identify and address both patient and provider-related digital barriers so as to avoid that the widespread implementation of virtual care in a manner which reinforces disparities in health access amongst already underserved and excluded groups [52].…”

“…Published evidence shows that the transition to virtual primary care did not unfold in the same manner across communities [52]. Proactive efforts are therefore needed to identify and address both patient and provider-related digital barriers so as to avoid that the widespread implementation of virtual care in a manner which reinforces disparities in health access amongst already underserved and excluded groups [52]. Equally, with regards to patient-centredness, a range of benefits and challenges have been identified.…”

Telehealth use and Satisfaction among U.S. Households: Results of a National Survey

“…Indeed, an examination of patients with a diagnosis of diabetes found that while office visits decreased during the pandemic, prescriptions and glycemic control remained steady, which might in part be due to the increased use of telehealth to support continued access to care ( 19 ). However, the COVID-19 pandemic has also hinted that uneven access and equity remain potential threats to patients’ access and experience that require continued attention ( 5 , 20 ).…”

Provision of Palliative Care during the COVID-19 Pandemic: A Systematic Review of Ambulatory Care Organizations in the United States

“…Important to note, disparities surrounding healthcare technologies (outside of just palliative care) do exist [ 22 ]. Specific challenges may include access to broadband internet in rural areas [ 22 , 23 ], socioeconomic factors [ 24 ], and even health literacy and education challenges [ 25 ]. These challenges and others are to be continuously addressed to help enable technology, an identified review construct in this study, to support the continuity of palliative care.…”