Published On May 20, 2021
It is now possible to imagine a world recovered from COVID-19. In that future, how will medicine have changed? These 10 essays explore the technical, social and political ripples of the pandemic.
The COVID-19 pandemic catalyzed a rapid uptake of telehealth, and most agree this change is here to stay. It does, however, raise a critical question: Will telehealth worsen health disparities, or can it be a tool to improve health equity? It all depends on how thoughtfully we adopt it.
The digital divide—the gulf between those with access to computers and high-speed internet and those without—has left a troubling mark in this pandemic. When in-person visits were largely unavailable, the digitally disconnected were unable to access any care. They have also been left behind in securing COVID-19 vaccine appointments distributed through online systems.
The ones affected are often vulnerable in other ways. One study published in JAMA last December showed that patients of older age, non-English language preference, Asian race and with Medicaid insurance were less likely to use telemedicine visits. Other studies have identified older patients, women and those in the Black and Latinx communities as less likely to participate in video visits. We cannot afford to shut these groups out.
And yet it’s important to also recognize how telehealth can help with reaching vulnerable populations. I have had video chats with patients as they sat in parked cars or break rooms, using their break time to fit in a quick follow-up for high blood pressure. Many of my lower-income patients are more willing to pursue specialty consultation by telehealth as opposed to an in-person visit, which requires time-intensive transportation into the city and expensive parking. Recently, one of my patients with newly diagnosed metastatic cancer was able to receive a second opinion regarding his therapeutic options from the comfort of his home and in the presence of his two children.
The pandemic should teach us that we need to embrace telehealth in a way that promotes equity rather than worsens disparities. This will take work. We will need to track race, ethnicity, language and income so we can understand who is left behind, shift our strategies and monitor our improvements. Health care systems and providers must advocate for universal broadband access and recognize that access to computers, tablets and smartphones is a social determinant of health.
Our health systems can also employ multimodal technology streams, rather than constraining all communication to our user-unfriendly online portals. A program at Mass General Brigham, for instance, used a texting option to successfully communicate key COVID-19 messaging in multiple languages to its patients. This program improved access to important information for many, including those with low English proficiency, those without regular access to a computer or email and those without an account on our online portal.
Continued reimbursement for telephone visits in addition to video visits will be crucial to promote equity, given that accessing and navigating video platforms is not open to everyone. As telemedicine leaps ahead, let’s remember to meet patients with the technology they have and know how to use today as we also work to expand everyone’s digital tools and expertise.
Sarah Matathia // family medicine specialist with MGH Everett Family Care Center
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