The digital divide: How COVID-19's telemedicine expansion could exacerbate disparities

Bakhtiar, M.; Elbuluk, Nada; Lipoff, Jules B.

doi:10.1016/j.jaad.2020.07.043

Cited by 100 publications

(83 citation statements)

References 3 publications

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“…The same digital divide also applies for public services, including education and health care, where they have shifted online. 81 , 82 , 83 Those with high-quality digital access continue to obtain key services, whereas those without connectivity find themselves or their children excluded from basic services such as schooling. 84 This split occurs both within and among countries because of income inequalities and insufficient decent work.…”

Section: Section 5: Addressing the Inequities Of The Pandemicmentioning

confidence: 99%

Lancet COVID-19 Commission Statement on the occasion of the 75th session of the UN General Assembly

Sachs¹,

Karim²,

Aknin³

et al. 2020

The Lancet

137

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The Lancet COVID-19 Commission was launched on July 9, 2020, to assist governments, civil society, and UN institutions in responding effectively to the COVID-19 pandemic. The Commission aims to offer practical solutions to the four main global challenges posed by the pandemic: suppressing the pandemic by means of pharmaceutical and non-pharmaceutical interventions; overcoming humanitarian emergencies, including poverty, hunger, and mental distress, caused by the pandemic; restructuring public and private finances in the wake of the pandemic; and rebuilding the world economy in an inclusive, resilient, and sustainable way that is aligned with the Sustainable Development Goals (SDGs) and the Paris Climate Agreement. Many creative solutions are already being implemented, and a key aim of the Commission is to accelerate their adoption worldwide.

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Section: Section 5: Addressing the Inequities Of The Pandemicmentioning

confidence: 99%

Lancet COVID-19 Commission Statement on the occasion of the 75th session of the UN General Assembly

Sachs¹,

Karim²,

Aknin³

et al. 2020

The Lancet

137

View full text Add to dashboard Cite

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“…Yet, not all barriers are eradicated. The current COVID‐19 pandemic has highlighted the potential widening of the digital divide due to health and economic disparities and lack of infrastructure in some communities (Almufleh & Givertz, 2020; Bakhtiar et al, 2020; Hirko et al, 2020; Khilnani et al, 2020; Nouri et al, 2020; Wosik et al, 2020). As many aspects of life in the United States moved online, older adults and those with greater economic disparities were unprepared for the impact and the resulting isolation (Conger & Griffith, 2020).…”

Section: Discussionmentioning

confidence: 99%

Lessons learned from the implementation of a video health coaching technology intervention to improve self‐care of family caregivers of adults with heart failure

Hirschman

Bowles

Garcia‐Gonzalez

et al. 2020

Research in Nursing & Health

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Individuals with heart failure (HF) typically live in the community and are cared for at home by family caregivers. These caregivers often lack supportive services and the time to access those services when available. Technology can play a role in conveniently bringing needed support to these caregivers. The purpose of this article is to describe the implementation of a virtual health coaching intervention with caregivers of HF patients (“Virtual Caregiver Coach for You”—ViCCY). A randomized controlled trial is currently in progress to test the efficacy of the intervention to improve self‐care. In this trial, 250 caregivers will be randomly assigned to receive health information via a tablet computer (hereafter, tablet) plus 10 live health coaching sessions delivered virtually (intervention group; n = 125) or health information via a tablet only (control group; n = 125). Each tablet has specific health information websites preloaded. To inform others embarking on similar technology projects, here we highlight the technology challenges encountered with the first 15 caregivers who received the ViCCY intervention and the solutions used to overcome those challenges. Several adaptations to the implementation of ViCCY were needed to address hardware, software, and network connectivity challenges. Even with a well‐designed research implementation plan, it is important to re‐examine strategies at every step to solve implementation barriers and maximize fidelity to the intervention. Researcher and interventionist flexibility in adapting to new strategies is essential when implementing a technology‐based virtual health coaching intervention.

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“…The advancement of teledermatology that has occurred gradually over the last few decades and more exponentially over 2020 during the COVID-19 pandemic should intuitively expand access to care, given teledermatology’s convenience, cost-effectiveness, and triage capabilities [ 61 •]. However, vulnerable patients, including those of lower socioeconomic standing, older individuals, and non-English-speaking patients may experience increased barriers to accessing health care via telemedicine, particularly video visits [ 62 •, 63 ••]. The equipment needed for video visits includes smartphones, tablets, or computers, and a reliable internet connection, which can be expensive and require technological literacy.…”

Section: Could Teledermatology Worsen Existing Health Care Disparitiementioning

confidence: 99%

“…In New York City, 50% of low-income houses lack internet access, and 26% of all Americans with an annual income of under $30,000 rely solely on mobile internet access [ 64 •, 65 •]. Beyond digital access, telehealth services must meet quality standards, and inconsistent quality may increasingly burden vulnerable populations [ 63 ••]. Studies have also shown that Medicaid patients are more likely to be referred for teledermatology visits and may be more vulnerable to possible diagnostic inadequacies [ 30 •].…”

Section: Could Teledermatology Worsen Existing Health Care Disparitiementioning

confidence: 99%

Teledermatology Addressing Disparities in Health Care Access: a Review

2021

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Purpose of Review Dermatologists have been at the forefront of researching telemedicine to expand access to care. The current COVID-19 pandemic has prompted even greater expansion and implementation of teledermatology. This review discusses the research examining the potential impact of teledermatology addressing disparities in care. Recent Findings Teledermatology appears to increase access to dermatology given expanded means to deliver care. Specifically, recent studies have found increased access among Medicaid-insured, resource-poor urban and rural, and elderly populations. Teledermatology implementation also facilitates education among providers at different levels of training. Still, as some patients have inconsistent access to the required technology, increased reliance on telemedicine may also potentially increase disparities for some populations. Summary Teledermatology may serve to reduce disparities in health care access in many underserved and marginalized communities. Future research should continue to study implementation, especially given the expansion during the COVID-19 pandemic. Ultimately, teledermatology may play an important role in ensuring equitable care access for all.

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The digital divide: How COVID-19's telemedicine expansion could exacerbate disparities

Cited by 100 publications

References 3 publications

Lancet COVID-19 Commission Statement on the occasion of the 75th session of the UN General Assembly

Lancet COVID-19 Commission Statement on the occasion of the 75th session of the UN General Assembly

Lessons learned from the implementation of a video health coaching technology intervention to improve self‐care of family caregivers of adults with heart failure

Teledermatology Addressing Disparities in Health Care Access: a Review

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