As the COVID-19 pandemic escalated in March and April 2020, many cardiologists made the transition to telemedicine, replacing face-to-face appointments with video conferences and phone calls. How did this necessary adjustment affect patient care? Did it help some patient groups more than others?
A group of researchers explored these very questions, sharing its findings in Circulation.
“The use of technology for maintenance of care may exacerbate inequities,” wrote first author Lauren A. Eberly, MD, MPH, Hospital of the University of Pennsylvania in Philadelphia, and colleagues. “Vulnerable patients, including poorer patients, older patients, and non-English speaking patients may have increased barriers to engaging in care via telemedicine, particularly video visits. The aim of this study was to compare the demographics of patients with completed telemedicine encounters in the current COVID-19 era at a large academic health system to those who were scheduled, but did not complete a visit.”
Eberly et al. tracked data from nearly 3,000 patient visits scheduled from March 16 to April 17, 2020, at the academic health system’s various cardiology clinics. Overall, 46% of those visits occurred as telemedicine visits; the remaining 54% were cancelations/no-shows.
Diving deeper into the data, the authors noted that patients who participated in video-based appointments as opposed to just phone calls were more likely to be male, less likely to be black and had a higher median household income.
Not speaking English was also independently associated with much less telemedicine use, a finding that caused the authors to call for the “rapid adoption” of improved translation technology and other solutions that could improve the overall telemedicine experience for non-English speaking patients.
In addition, women were independently associated with less telemedicine and video use during this time period.
“This may be due to disproportionate distribution of child care duties as children stay home or differing employment strains, but further investigation is needed,” the authors wrote.
Another key difference was that households with a median household income of less than $50,000 were independently associated with fewer video-based telehealth visits. This could be an issue related to internet access or smartphone use, the team noted, and strategies to address this disparity are needed.
“The COVID-19 pandemic has been the great unequalizer, revealing the many ways in which the American healthcare system fails to provide equitable care,” the authors wrote. “Our results suggest that in the current COVID-19 era, inequities may be compounded even among non-COVID patients in outpatient routine care via inequitable access to telemedical care for female, non-English speaking, older, and poorer patients.”
Concluding its assessment, the team also emphasized that the conversation surrounding patient demographics and telemedicine goes well beyond any specific virus or incident.
“The foundation we develop now for telemedicine visits is sure to last past the current COVID-19 crisis,” Eberly and colleagues concluded. “As we further refine our telemedicine practice, attention to equity is essential.”
Michael has more than 16 years of experience as a professional writer and editor. He has written at length about cardiology, radiology, artificial intelligence and other key healthcare topics.