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Disclosures: The authors report no relevant financial disclosures.
June 18, 2020
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Telehealth visits during COVID-19 may exacerbate inequities in cardiology care

Source/Disclosures
Disclosures: The authors report no relevant financial disclosures.
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Lauren A. Eberly

Inequities persist in telehealth during the COVID-19 pandemic, as patients who completed telehealth visits at cardiology clinics were more likely to be older men who spoke English, according to a study published in Circulation.

“We have seen how COVID-19 has been the great unequalizer,” Lauren A. Eberly, MD, MPH, cardiology fellow at the University of Pennsylvania, told Healio. “The findings of this study demonstrate significant inequities are also present among non-COVID patients in accessing necessary telemedicine care. … These results call for immediate implementation of strategies to ensure more equitable access to telemedicine care.”

Less than half of patients completed a scheduled telehealth visit via phone or video call.

Scheduled telehealth visits

Researchers analyzed data from 2,940 patients who were scheduled for a telehealth visit at general or subspeciality cardiology clinics between March 16 and April 17.

“As we transitioned to telemedicine care, we became concerned that given the digital divide, the use of technology for maintenance of access to outpatient care may worsen inequities, as some patients may have increased barriers to engaging in care,” Eberly said in an interview. “We initiated this study as we began to ramp our telemedicine program to ensure we developed proactive approaches to identify and mitigate inequities.”

Billing data determined which patients completed the encounter through telephone or video or did not show or canceled. ZIP codes along with the American Community Survey data were used to determine a patient’s household income.

Of the patients in the study, 46% completed the telehealth encounter and 54% had a no-show or canceled visit. Compared with patients who had a no-show or canceled visit, those who completed a telehealth visit were slightly older (63 years vs. 62 years; P < .0001), more likely to speak English (99% vs. 98%; P = .03) and more likely to be male (51% vs. 44%; P < .0001).

“One of most important takeaway points from our study is the need for end-to-end telemedicine support for non-English speaking patients,” Eberly told Healio. “More formalized outreach to contact patients in their native language, seamless end-to-end (from check-in to visit follow-up) integration of translation services into telemedicine visit technology and translation of all visit instructions to access telemedicine technologies may help address this, and efforts are already underway.”

No differences were observed between groups with regard to insurance/payor class (P = .12), race/ethnicity (P = .25) or household income (P = .38).

Researchers also compared patients who completed visits via video compared with telephone only. Patients who completed video visits were more likely to be men (50% vs. 42%; P = .01) and more likely to have household income between $50,000 and $100,000 (54% vs. 49%) or greater than $100,000 (24% vs. 19%). These patients were also less likely to be black than those who completed visits using telephone alone (24% vs. 34%; P < .01).

‘Foundation of equity’

“Many have been anxiously awaiting a return to ‘normal,’” Eberly said in an interview. “This study serves as a reminder of the inequity that plagues the American health care system. As we build and refine our telemedicine health system, we must start prioritizing those who have been marginalized and build our telemedicine platforms on a foundation of equity. Attention to equity is paramount.”

For the latest news on COVID-19 including case counts, information about the global public health response and emerging research, please visit the COVID-19 Resource Center on Healio. 

For more information:

Lauren A. Eberly, MD, MPH, can be reached at lauren.eberly@pennmedicine.upenn.edu; Twitter: @eberly_lauren.