LinkHealth
Telehealth is a crucial advancement in healthcare, utilizing information and communication technology to facilitate interactions between healthcare professionals and patients. This can occur in two primary formats: synchronous, where exchanges happen in real-time through video conferencing or telephone calls, and asynchronous, which includes methods like emails and other store-and-forward techniques(1).
Research indicates that telehealth is particularly effective in managing chronic conditions that necessitate frequent and close engagement with healthcare providers(2). It allows for continuous monitoring of patient's symptoms and diagnostic outcomes, thereby enhancing the overall quality of care and patient satisfaction. Furthermore, telehealth offers flexibility and accessibility, making it a viable option for many individuals seeking medical support(3).
Key benefits of telehealth include:
Continuous Monitoring: Healthcare providers can track patient progress in real-time, adjusting treatment plans as necessary.
Enhanced Communication: Patients can easily communicate their concerns, leading to quicker adjustments in care.
Reduced Travel Time: Patients save time and resources by eliminating the need for in-person visits, which can benefit those with mobility challenges.
Access to Specialists: Telehealth can connect patients in remote areas with specialists who may not be easily accessible locally.
Improved Patient Engagement: The convenience of telehealth can encourage more patients to engage in their healthcare, leading to better health outcomes.
Telehealth is proving to be a transformative approach in healthcare delivery, especially for chronic conditions where consistent engagement is critical. Before the start of the COVID-19 public health emergency, the adaptation of telehealth was slow and fragmented due to many reasons, including clinician willingness and acceptance of telehealth(4,5), technological limitations, and a lack of funding(6,7,8). Consequently, telehealth use was very limited, even by patients in rural and remote locations lacking localized healthcare facilities(9).
However, during the COVID-19 public health emergency, there was a rapid and substantial increase in the use of telehealth to provide patients with routine care as safely as possible(10). The growth in telehealth during this period was important as it allowed healthcare providers to meet many of their patient's needs while helping keep them safe from infectious diseases that they might be exposed to in close quarters at healthcare facilities(11).
Additionally, the recent COVID-associated surge in telehealth has bolstered increased access to care, facilitated face-to-face interaction, and enhanced the overall convenience of care. Now, patients can meet with their doctor more efficiently, not only saving valuable time but also reducing the economic cost associated with taking time off from work or securing childcare.
While the COVID-19 public health emergency stimulated a surge in the adaptation and deployment of telehealth provisions and is generally considered a positive step towards improvements to access, delivery of healthcare, and the management of disease- the social determinants of health have affected the use of these services in certain demographic communities.
In 2005, UCL Professor Michael Marmot introduced the concept of Social Determinants of Health (SDOH) based on burgeoning research identifying social factors at the root of many inequalities in health outcomes. Marmot noted that “the conditions in which people are born, grow, live, work and age” affected their health outcomes(12). Researchers have spent decades documenting disparities in healthcare(13,14,15,16).
As defined by health researcher Dr. Paula Braveman in 2006, a health disparity exerts a specific kind of differential influence on health that is frequently shaped by policies; it is a difference in which disadvantaged social groups—including the poor, racial and ethnic minorities, women, or other groups who commonly experience discrimination and social disadvantage—systematically experience worse health or greater health risks than more advantaged social groups(17).
Health disparities continue to significantly impact patient outcomes, even concerning telehealth(18). Early evidence highlights the existence of notable socio-economic disparities in telehealth usage during the COVID-19 public health emergency(19). In 2020, reports indicated that urban and rural areas alike exhibited lower telehealth service utilization among black individuals(20). These disparities in access to telehealth resources can worsen chronic disease outcomes(21).
Research has shown that populations over 65 years of age, those identifying as Black or Spanish-speaking, and individuals residing in areas with limited broadband access were less inclined to utilize video consultations. Key factors contributing to these disparities include geography, racial identity, and socioeconomic status, all of which intersect with inequities in broadband availability, creating a pronounced "digital divide."(20,22,23)
The digital divide is a complex issue tied to individuals' access to technology and the subsequent health consequences stemming from information inequalities. Communication experts Jan Van Dijk and Kenneth Hacker have identified four interconnected barriers impacting technology access and usage(24). The first barrier relates to a lack of digital experience, which may arise from either disinterest or anxiety regarding new technologies. The second pertains to insufficient material access to technology or network services. The third barrier focuses on digital skills, where a lack of digital competence and social support hampers usage. Finally, the last component involves inadequate opportunities for significant technology usage, which can perpetuate these health disparities.
Consequently, problems related to the digital divide extend beyond mere access to reliable high-speed internet and the necessary diversity of hardware and software for effective telehealth engagement. They also encompass challenges in Internet skills(25). The multi-layered nature of the digital divide has been reframed by communications scholar Massimo Ragnedda in terms of Digital Capital. Ragnedda defines digital capital as “the accumulation of digital competencies (information, communication, safety, content-creation, and problem-solving) and digital technology.”(26)
Furthermore, digital capital can be conceptualized as an interplay between adopted digital competencies and externalized technological resources that can be accumulated and transferred across different contexts(26). Ultimately, the quantity of digital capital an individual possesses directly impacts the quality of their Internet experience, which in turn can translate into economic, social, cultural, and political capital(26).
Like the health disparities associated with in-person care, evidence suggests a degree of intersectionality associated with inequalities in telehealth. Geography, race/ethnicity, native language, socioeconomic status, gender identity, and digital capital all exert a varying degree of influence on individuals' telehealth engagement and outcomes(27). Because of these various intersectionalities, telehealthcare providers are required to develop new skills in virtual rapport, which includes demonstrating empathy, the ability to facilitate efficacious virtual physical examinations and diagnoses, as well as demographically specific counseling skills. Unfortunately, this presents a significant challenge and will require considerable effort to achieve.
In summary, although telehealth has huge potential to surmount many longstanding healthcare problems, the digital divide presents a significant challenge to equitable telehealth adoption. To reduce inequalities and improve the effectiveness of telehealth, future telehealth interventions must be developed and implemented to meet the needs specific to people in low socioeconomic populations. Successfully building more equitable healthcare systems via telehealth will require the deployment of social capital resources, financial incentives, and political will among care providers, the health insurance industry, and government officials. Addressing these challenges is crucial for ensuring that the benefits of telehealth reach all segments of the population.
Citations:
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Khilnani, A., Schulz, J., & Robinson, L. (2020). The COVID-19 pandemic: New concerns and connections between eHealth and digital inequalities. Journal of Information, Communication and Ethics in Society. https://doi.org/10.1108/JICES-07-2020-0091
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Smith, A. C., Thomas, E., Snoswell, C. L., Haydon, H., Mehrotra, A., Clemensen, J., & Caffery, L. J. (2020). Telehealth for global emergencies: Implications for coronavirus disease 2019 (COVID-19). Journal of Telemedicine and Telecare, 26(5), 309-313. https://doi.org/10.1177/1357633X20916567
Mehrotra, A., Bhatia, R. S., & Snoswell, C. L. (2021). Paying for telemedicine after the pandemic. JAMA, 325(5), 431-432. https://doi.org/10.1001/jama.2020.26112
Peddle, K. (2007). Telehealth in context: Socio-technical barriers to telehealth use in Labrador, Canada. Computer Supported Cooperative Work (CSCW), 16(6), 595-614. https://doi.org/10.1007/s10606-007-9051-8
Samson, L. W., Tarazi, W., Turrini, G., & Sheingold, S. (2021). Medicare beneficiaries’ use of telehealth in 2020: Trends by beneficiary characteristics and location. Office of the Assistant Secretary for Planning and Evaluation. https://aspe.hhs.gov/reports/medicare-beneficiaries-use-telehealth-2020
Haleem, A., Javaid, M., Singh, R. P., & Suman, R. (2021). Telemedicine for healthcare: Capabilities, features, barriers, and applications. Sensors International, 2, 100117. https://doi.org/10.1016/j.sintl.2021.100117
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Braveman, P., & Gottlieb, L. (2014). The social determinants of health: It’s time to consider the causes of the causes. Public Health Reports, 129(1_suppl2), 19-31. https://doi.org/10.1177/00333549141291S206
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Pierce, R. P., & Stevermer, J. J. (2020). Disparities in use of telehealth at the onset of the COVID-19 public health emergency. Journal of Telemedicine and Telecare. https://doi.org/10.1177/1357633X20963893
Samson, L. W., Tarazi, W., Turrini, G., & Sheingold, S. (2021). Medicare beneficiaries’ use of telehealth in 2020: Trends by beneficiary characteristics and location. Office of the Assistant Secretary for Planning and Evaluation. https://aspe.hhs.gov/reports/medicare-beneficiaries-use-telehealth-2020
Rodriguez, J. A., Betancourt, J. R., Sequist, T. D., & Ganguli, I. (2021). Differences in the use of telephone and video telemedicine visits during the COVID-19 pandemic. American Journal of Managed Care, 27(1). https://doi.org/10.37765/ajmc.2021.88573
Zahnd, W. E., Bell, N., & Larson, A. E. (2022). Geographic, racial/ethnic, and socioeconomic inequities in broadband access. The Journal of Rural Health, 38(3), 519-526. https://doi.org/10.1111/jrh.12608
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