Using telehealth consultations for healthcare provision to patients from non-Indigenous racial/ethnic minorities: a systematic review

Truong, Mandy; Yeganeh, Ladan; Cook, Olivia; Wong, Pauline; Allen, Jacqui

doi:10.1093/jamia/ocac015

Cited by 47 publications

(34 citation statements)

References 71 publications

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“…There was early speculation that expansion of telemedicine could improve access to subspecialty care, especially for patients in rural areas and those with limited access to transportation [ 2 ]. However, important studies have found that telehealth may paradoxically widen inequities in health access [ 3 ], secondary to high costs and limitations in patients’ digital and health literacy [ 4 ]. These findings encompass both overall utilization of telehealth and nuances such as the use of video-enhanced televisits.…”

Section: Introductionmentioning

confidence: 99%

Disparities in Telehealth use During the COVID-19 Pandemic

Lau

Anand

Ramírez

et al. 2022

J Immigrant Minority Health

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The coronavirus 2019 pandemic led to rapid expansion of outpatient telemedicine. We sought to characterize patient factors influencing outpatient teleneurology utilization at an urban safety-net hospital. We reviewed all neurology televisits scheduled between June 15, 2020 to April 15, 2021. We used the chi-squared test and multivariate logistic regression to characterize patient demographic factors associated with televisit completion and video use. Of 8875 scheduled televisit encounters, 7530 were completed successfully, 44% via video. Non-English speaking patients, Black patients, Latinx patients, and those with a zip code-linked annual income less than $50,000 were less likely to successfully complete a scheduled televisit. The same demographic groups other than Latinx ethnicity were also less likely to use the video option. Our study found unequal telehealth utilization based on patients’ demographic factors. Currently declining telemedicine reimbursement rates asymmetrically affect audio-only visits, which may limit telehealth access for vulnerable patient populations.

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Section: Introductionmentioning

confidence: 99%

Disparities in Telehealth use During the COVID-19 Pandemic

Lau

Anand

Ramírez

et al. 2022

J Immigrant Minority Health

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“…In our study, we found that intervention participants experienced barriers more commonly among socioeconomically disadvantaged people, including poor internet connections [14,88], small screen sizes because of mobile device use [80][81][82] and distractions in the physical environment [82,85]. Notably, these can increase cognitive load [21,22,80].…”

Section: Helpers' Emergent Approaches In Targeting Cognitive Loadmentioning

confidence: 88%

Targeting Patients’ Cognitive Load for Telehealth Video Visits Through Student-Delivered Helping Sessions at a United States Federally Qualified Health Center: Equity-Focused, Mixed Methods Pilot Intervention Study

et al. 2023

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Background The task complexity involved in connecting to telehealth video visits may disproportionately impact health care access in populations already experiencing inequities. Human intermediaries can be a strategy for addressing health care access disparities by acting as technology helpers to reduce the cognitive load demands required to learn and use patient-facing telehealth technologies. Objective We conducted a cognitive load theory–informed pilot intervention involving warm accompaniment telehealth helping sessions with patients at a Federally Qualified Health Center (FQHC). We demonstrate how to design and report recruitment methods, reach, delivery process, and the preliminary impact of a novel equity-focused intervention. Methods Early into the COVID-19 pandemic a telehealth helping session was offered to patients at FQHC via phone. Graduate students led the sessions on conducting a telehealth video test run or helping with patient portal log-in. They systematically recorded their recruitment efforts, intervention observations, and daily reflection notes. Following the intervention, we asked the intervention participants to participate in an interview and all patients who had telehealth visits during and 4 weeks before and after the intervention period to complete a survey. Electronic health records were reviewed to assess telehealth visit format changes. Descriptive and inferential statistical analyses of the recruitment records, electronic health record data, and surveys were performed. Through integrative analysis, we developed process-related themes and recommendations for future equity-focused telehealth interventions. Results Of the 239 eligible patients, 34 (14.2%) completed the intervention and 3 (1.2%) completed subsequent interviews. The intervention participants who completed the survey (n=15) had lower education and less technological experience than the nonintervention survey participants (n=113). We identified 3 helping strategies for cognitive load reduction: providing step-by-step guidance for configuring and learning, building rapport to create confidence while problem-solving, and being on the same page to counter informational distractions. Intervention participants reported increased understanding but found that learning the video visit software was more difficult than nonintervention participants. A comparison of visit experiences did not find differences in difficulty (cognitive load measure) using telehealth-related technologies, changes to visit modality, or reported technical problems during the visit. However, the intervention participants were significantly less satisfied with the video visits. Conclusions Although a limited number of people participated in the intervention, it may have reached individuals more likely to need technology assistance. We postulate that significant differences between intervention and nonintervention participants were rooted in baseline differences between the groups’ education level, technology experience, and technology use frequency; however, small sample sizes limit conclusions. The barriers encountered during the intervention suggest that patients at FQHC may require both improved access to web-based technologies and human intermediary support to make telehealth video visits feasible. Future large, randomized, equity-focused studies should investigate blended strategies to facilitate video visit access.

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“…While telehealth is a critical tool in care and its popularity has increased [ 38 ], there remain challenges and patients continue to prefer in person appointments [ 39 ]. This is especially true for minority and refugee patients who are dealing with limited digital and health literacy [ 40 , 41 ].…”

Section: Discussionmentioning

confidence: 99%

Exploring the Digital Divide among the Bhutanese Refugee Community during COVID-19: Engaged Research in Action

Cohen

Maleku

Pyakurel³

et al. 2022

IJERPH

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The digital divide proved a critical barrier to accessing information and healthcare during the COVID-19 pandemic and negatively impacted the Bhutanese refugee community. Moving beyond a technological model of the digital divide that highlights a lack of access to computers and the internet, we engaged the community to co-produce a dynamic approach that identifies the impact of socio-cultural and socio-environmental factors as well. Our paper reports on our community-academic research partnership and explores how the digital divide exacerbates health disparities in a midwestern Bhutanese refugee community. Combining the efforts of the community, anthropologists and social workers, this paper reports on the health disparities that confront the community as well as interventions designed to mitigate social inequities.

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Using telehealth consultations for healthcare provision to patients from non-Indigenous racial/ethnic minorities: a systematic review

Cited by 47 publications

References 71 publications

Disparities in Telehealth use During the COVID-19 Pandemic

Disparities in Telehealth use During the COVID-19 Pandemic

Targeting Patients’ Cognitive Load for Telehealth Video Visits Through Student-Delivered Helping Sessions at a United States Federally Qualified Health Center: Equity-Focused, Mixed Methods Pilot Intervention Study

Exploring the Digital Divide among the Bhutanese Refugee Community during COVID-19: Engaged Research in Action

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