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Telehealth Care Access Yields Health Disparities Amid COVID-19

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Telehealth improves access to care

By Hannah Nelson

– New research conducted by the Baylor College of Medicine shows that there are internet access disparities for individuals suffering from chronic health conditions such as hypertension and diabetes, thereby hampering telehealth care access and creating health disparities.

Telehealth can be a valuable solution for access to care during a pandemic, especially for those with chronic diseases such as diabetes and hypertension, as they are at higher risk for severe illness from COVID-19.

“Some patients may be avoiding the doctor’s office for follow-up visits due to fear of exposure to the virus, so chronic diseases may actually worsen,” explained Dr. Salim Virani, a professor of medicine-cardiology at Baylor and a cardiologist at the Michael E. DeBakey Veterans Affairs Medical Center. “Telehealth can be a valuable solution.”

The study, published in the most recent edition of Diabetes Care, reviewed data from the 2016-2017 Behavioral Risk Factor Surveillance System, a CDC telephone questionnaire that collects national data on health-related behaviors, conditions, and the use of preventative services.

They used data from 910,655 participants to study the intersections between chronic illnesses, internet use, and race based on the question, “Have you used the internet in the past 30 days?”

The findings show that 65 percent of individuals with diabetes had accessed the internet in the past 30 days, compared to 86 percent of individuals without diabetes. For those with hypertension, the prevalence of internet use was 74 percent compared to 89 percent of those without hypertension.

The researchers found that Black and Hispanic patients with diabetes or hypertension had a much lower rate of internet use compared to White patients. For instance, Black patients with these chronic illnesses had 51 percent lower odds of internet use compared to White patients with chronic illnesses. Hispanic patients with chronic illnesses had 42 percent lower odds of internet use compared to White patients with chronic illnesses.

“Being able to identify these disparities is important from a public health policy standpoint to ensure that all patients receive equitable healthcare,” Virani said.

“Efforts are needed to mitigate these disparities, especially since Black and Hispanic populations have higher rates of hypertension and diabetes,” Virani continued. “Given that morbidity and mortality from COVID-19 is much higher in patients with diabetes or hypertension, and that these patients require chronic care that is now delivered using telehealth, efforts are urgently needed to ensure that the racial and ethnic disparities in outcomes seen in COVID-19 do not spill over into chronic disease care as we shift to a telehealth model of care delivery.”

In another study published in the Journal of the American Medical Informatics Association based on data from Mount Sinai Hospital in New York City, three health disparities in telehealth access were found: race, age, and language preference.

Reviewing data from 40,000 patient encounters during New York’s COVID-19 surge (March 20 to May 18), researchers found that Black and Hispanic patients were 4.3-times and 2.5-times more likely to use the ED over telehealth than their White and Asian peers, respectively. 

Age played a large role in the rate of telehealth utilization for all patients. For instance, 41 percent of patients ages 18 to 29 used telehealth, while 47 percent of those ages 30 to 49 did the same. However, only 24 percent of adults over age 65 used telehealth.

Lastly, language determined the rate at which patients used telehealth or the ED. Only about 25 percent of patients who preferred a language other than English chose to use telehealth over the ED.

The researchers suggested that racial disparities in telehealth access were the most pressing of their findings.

“A number of factors may contribute to our findings, such as research (prior to COVID-19) that racial/ethnic differences in ER use versus alternative care settings for a variety of conditions – differences that persist after controlling for variables like [socioeconomic status], insurance status and usual-source-of care,” the researchers said.

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