Video consultations will increase health inequality without the correct infrastructure put in place

Mehmi, Ashley; Winters, David; Green, James S. A.

doi:10.1136/bmj.m4498

Cited by 5 publications

(4 citation statements)

References 6 publications

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“…Mehmi et al [ 64 ] further discussed how they expected video consultations to increase health inequality if the correct infrastructure is not put in place. Thronson et al [ 65 ] considered the underlying cause of this “pandemic of health care inequity” [ 50 ] to be access—the disadvantaged simply cannot access telemedicine or home monitoring tools.…”

Section: Resultsmentioning

confidence: 99%

“…The 17 peer-reviewed research papers (summarized in Table 1) comprised 1 (6%) systematic review [48], 1 (6%) narrative synthesis [49], 7 (41%) retrospective audits of medical records [56,57,[59][60][61][62]70], 3 (18%) quantitative surveys [5,50,58], and 5 (29%) qualitative studies based on semistructured interviews [5,51,52,54,55]. A further 37% (10/27) of the articles (Table 2) commented on others' research, reflected on findings from clinical practice, or proposed measures to reduce digital health disparities [11,21,22,[63][64][65][66][67][68][69].…”

Section: Description Of the Data Setmentioning

confidence: 99%

“…Discussion of challenges encountered in ensuring equitable access to telemedicine in the early weeks of the pandemic Commentary emerging from practice, by clinicians at an academic medical center in San Francisco with 3 clinics including an urban "safety-net" service Nouri et al [22], 2020, United States To discuss disparities in access to telemedicine among vulnerable patients and evaluate why patients could not access the web-based system at CARES clinics Editorial by directors of free CARES a clinics in South Carolina Ramsetty and Adams [63], 2020, United States Authors criticize a BMJ article for failing to address digital disparities, notably relating to lack of effective internet access in some geographical areas, digital poverty (inability to afford a device or adequate data package), poor digital skills and confidence, refugee and other uncertain citizenship status, and lack of space and privacy at home Commentary on 2 articles, one arguing for the benefits of video consultations and one about health inequalities exposed by the pandemic Mehmi et al [64], 2020, United Kingdom Authors comment that the empirical study failed to capture a key finding from their own clinical experience (supported by audit data): that web-based visits (by video) were rarely taken up by the homeless, limited-English speakers, and those in a "racially diverse safety-net population"…”

Section: Aim Of Paper Context Author Year and Countrymentioning

confidence: 99%

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Desperately Seeking Intersectionality in Digital Health Disparity Research: Narrative Review to Inform a Richer Theorization of Multiple Disadvantage

et al. 2022

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Background Digital consultations between patients and clinicians increased markedly during the COVID-19 pandemic, raising questions about equity. Objective This study aimed to review the literature on how multiple disadvantage—specifically, older age, lower socioeconomic status, and limited English proficiency—has been conceptualized, theorized, and studied empirically in relation to digital consultations. We focused mainly on video consultations as they have wider disparities than telephone consultations and relevant data on e-consultations are sparse. Methods Using keyword and snowball searching, we identified relevant papers published between 2012 and 2022 using Ovid MEDLINE, Web of Science, Google Scholar, and PubMed. The first search was completed in July 2022. Papers meeting the inclusion criteria were analyzed thematically and summarized, and their key findings were tabulated using the Grading of Recommendations Assessment, Development, and Evaluation Confidence in the Evidence from Reviews of Qualitative Research criteria. Explanations for digital disparities were critically examined, and a search was undertaken in October 2022 to identify theoretical lenses on multiple disadvantage. Results Of 663 articles from the initial search, 27 (4.1%) met our inclusion criteria. In total, 37% (10/27) were commentaries, and 63% (17/27) were peer-reviewed empirical studies (11/27, 41% quantitative; 5/27, 19% qualitative; 1/27, 4% mixed methods; 1/27, 4% systematic reviews; and 1/27, 4% narrative reviews). Empirical studies were mostly small, rapidly conducted, and briefly reported. Most studies (25/27, 93%) identified marked digital disparities but lacked a strong theoretical lens. Proposed solutions focused on identifying and removing barriers, but the authors generally overlooked the pervasive impact of multiple layers of disadvantage. The data set included no theoretically informed studies that examined how different dimensions of disadvantage combined to affect digital health disparities. In our subsequent search, we identified 3 theoretical approaches that might help account for these digital disparities. Fundamental cause theory by Link and Phelan addresses why the association between socioeconomic status and health is pervasive and persists over time. Digital capital theory by Ragnedda and Ruiu explains how people mobilize resources to participate in digitally mediated activities and services. Intersectionality theory by Crenshaw states that systems of oppression are inherently bound together, creating singular social experiences for people who bear the force of multiple adverse social structures. Conclusions A limitation of our initial sample was the sparse and undertheorized nature of the primary literature. The lack of attention to how digital health disparities emerge and play out both within and across categories of disadvantage means that solutions proposed to date may be oversimplistic and insufficient. Theories of multiple disadvantage have bearing on digital health, and there may be others of relevance besides those discussed in this paper. We call for greater interdisciplinary dialogue between theoretical research on multiple disadvantage and empirical studies on digital health disparities.

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Section: Resultsmentioning

confidence: 99%

Section: Description Of the Data Setmentioning

confidence: 99%

Section: Aim Of Paper Context Author Year and Countrymentioning

confidence: 99%

See 1 more Smart Citation

Desperately Seeking Intersectionality in Digital Health Disparity Research: Narrative Review to Inform a Richer Theorization of Multiple Disadvantage

et al. 2022

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“…Use of video consultations was also higher in the most socioeconomically advantaged areas compared to areas of lower socioeconomic advantage, highlighting persistent inequity observed in Australia and abroad [ 20 , 33 , 34 ]. Although it has been shown that there were higher number of residents in MM1 (metropolitan area) in the highest deciles of the socioeconomic index [ 17 ], we did not observe any differences in the use of telehealth by regionality (ie, MMM).…”

Section: Discussionmentioning

confidence: 99%

Use of General Practitioner Telehealth Services During the COVID-19 Pandemic in Regional Victoria, Australia: Retrospective Analysis

Savira¹,

Orellana²,

Hensher³

et al. 2023

J Med Internet Res

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Background In March 2020, the Australian Government expanded general practitioner (GP) telehealth services in response to the COVID-19 pandemic. Objective This study sought to assess use patterns of GP telehealth services in response to changing circumstances (before and during the COVID-19 pandemic and with or without a lockdown) in regional Victoria, Australia. Methods We conducted a secondary analysis of monthly Medicare claims data from July 2019 to June 2021 from 140 regional GP practices in Western Victoria. The longitudinal patterns of proportion of GP telehealth consultations stratified by type of consultation (ie, videoconference vs telephone) and by geographical, consumer, and consultation characteristics were analyzed. Results Telehealth comprised 25.8% (522,932/2,025,615) of GP consultations over the 2-year period. After the introduction of the Australian telehealth expansion policy in March 2020, there was a rapid uptake in GP telehealth services (including telephone and video services), from 0% before COVID-19 to 15% (11,854/80,922) of all consultations in March 2020, peaking at 55% (50,828/92,139) in August 2020. Thereafter, the use of telehealth declined steadily to 31% (23,941/77,344) in January 2021 and tapered off to 28% (29,263/103,798) in June 2021. Telephone services and shorter consultations were the most dominant form, and those aged 15-64 years had higher telehealth use rates than younger or older age groups. The proportion of video consultations was higher during periods with government-imposed lockdowns and higher in the most socioeconomically advantaged areas compared to less socioeconomically advantaged areas. Conclusions Our findings support the continuation of telehealth use in rural and regional Australia post pandemic. Future policy must identify mechanisms to reduce existing equity gaps in video consultations and consider patient- and system-level implications of the dominant use of short telephone consultations.

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Coping with COVID-19: The WeChat Way

Andriano-Moore

Cai

2022

Coping With COVID-19, the Mobile Way

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Video consultations will increase health inequality without the correct infrastructure put in place

Cited by 5 publications

References 6 publications

Desperately Seeking Intersectionality in Digital Health Disparity Research: Narrative Review to Inform a Richer Theorization of Multiple Disadvantage

Desperately Seeking Intersectionality in Digital Health Disparity Research: Narrative Review to Inform a Richer Theorization of Multiple Disadvantage

Use of General Practitioner Telehealth Services During the COVID-19 Pandemic in Regional Victoria, Australia: Retrospective Analysis

Coping with COVID-19: The WeChat Way

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