“Can you see my screen?” Addressing Racial and Ethnic Disparities in Telehealth

Laurencin CT, McClinton A. The COVID-19 pandemic: a call to action to identify and address racial and ethnic disparities. J Racial Ethn Health Disparities. 2020;7(3):398–402. https://doi.org/10.1007/s40615-020-00756-0.

Flodgren G, Rachas A, Farmer AJ, Inzitari M, Shepperd S. Interactive telemedicine: effects on professional practice and health care outcomes. Cochrane Database Syst Rev. 2015;2015(9):CD002098.

Bashi N, Karunanithi M, Fatehi F, Ding H, Walters D. Remote monitoring of patients with heart failure: an overview of systematic reviews. J Med Internet Res. 2017;19(1):e18.

Dalouk K, Gandhi N, Jessel P, MacMurdy K, Zarraga IG, Lasarev M, Raitt M. Outcomes of telemedicine video-conferencing clinic versus in-person clinic follow-up for implantable cardioverter-defibrillator recipients. Circ Arrhythm Electrophysiol. 2017;10(9):e005217.

van Deursen AJ, van Dijk JA. The first-level digital divide shifts from inequalities in physical access to inequalities in material access. New Media Soc. 2019;21(2):354–75. https://doi.org/10.1177/1461444818797082.

Gottlieb LM. Learning from Alma Ata: the medical home and comprehensive primary health care. J Am Board Fam Med. 2009;22(3):242–6. https://doi.org/10.3122/jabfm.2009.03.080195.

Tuckson RV, Edmunds M, Hodgkins ML. Telehealth. N Engl J Med. 2017;377(16):1585–92. https://doi.org/10.1056/NEJMsr1503323.

Board on Health Care Services, Medicine I of. The evolution of telehealth: where have we been and where are we going? November 2012.

Wootton R. Recent advances: telemedicine. BMJ. 2001;323(7312):557–60. https://doi.org/10.1136/bmj.323.7312.557.

Kaiser Permanente’s system capabilities to suppress COVID-19 | Catalyst non-issue content. NEJM Catalyst Innovations in Care Delivery.

Chen J, Amaize A, Barath D. Evaluating telehealth adoption and related barriers among hospitals located in rural and urban areas. J Rural Health. 2020. https://doi.org/10.1111/jrh.12534.

Baum A, Kaboli PJ, Schwartz MD. Reduced in-person and increased telehealth outpatient visits during the COVID-19 pandemic. Ann Intern Med. 2021;174(1):129–31. https://doi.org/10.7326/M20-3026. Baum et al. describe chranges in the number of face-to-face visits and telemedicine visits at outpatient facilities during the initial 10 weeks of the COVID-19 pandemic.

Medicare telemedicine health care provider fact sheet | CMS. (n.d.). . Retrieved August 19, 2021, from https://www.cms.gov/newsroom/fact-sheets/medicare-telemedicine-health-care-provider-fact-sheet

Ferdinand KC, Hutchinson B, Haynes N, Ofili E. ABC webinars | association of Black cardiologists. Presented at the Optimizing the Practice of Cardiovascular Medicine in the COVID-19 Era. 2020.

The meaning of digital readiness | Pew Research Center. https://www.pewresearch.org/internet/2016/09/20/the-meaning-of-digital-readiness/. Accessed 27 Jan 2021.

Norman CD, Skinner HA. eHealth literacy: essential skills for consumer health in a networked world. J Med Internet Res. 2006;8(2):e9.

Lower-income Americans still lag in tech adoption | Pew Research Center. https://www.pewresearch.org/fact-tank/2019/05/07/digital-divide-persists-even-as-lower-income-americans-make-gains-in-tech-adoption/. Accessed 17 Jan 2021.

Smartphones help blacks, Hispanics close digital gap with whites | Pew Research Center. https://www.pewresearch.org/fact-tank/2019/08/20/smartphones-help-blacks-hispanics-bridge-some-but-not-all-digital-gaps-with-whites/. Accessed 17 Jan 2021.

The Latino digital divide: the native born versus the foreign born | Pew Research Center. https://www.pewresearch.org/hispanic/2010/07/28/the-latino-digital-divide-the-native-born-versus-the-foreign-born/. Accessed 17 Jan 2021.

Digital gap between rural and nonrural America persists | Pew Research Center. https://www.pewresearch.org/fact-tank/2019/05/31/digital-gap-between-rural-and-nonrural-america-persists/. Accessed 17 Jan 2021.

10% of Americans don’t use the internet | Pew Research Center. https://www.pewresearch.org/fact-tank/2019/04/22/some-americans-dont-use-the-internet-who-are-they/. Accessed 27 Jan 2021.

Many Americans hungry for help in making more informed decisions | Pew Research Center. https://www.pewresearch.org/fact-tank/2017/11/29/many-americans-especially-blacks-and-hispanics-are-hungry-for-help-as-they-sort-through-information/. Accessed 17 Jan 2021.

Maddison R, Rawstorn JC, Stewart RAH, Benatar J, Whittaker R, Rolleston A, Jiang Y, et al. Effects and costs of real-time cardiac telerehabilitation: randomised controlled non-inferiority trial. Heart. 2019;105(2):122–9.

Bassett DR, Toth LP, LaMunion SR, Crouter SE. Step counting: a review of measurement considerations and health-related applications. Sports Med. 2017;47(7):1303–15. https://doi.org/10.1007/s40279-016-0663-1.

Wearable tech fitness trackers on the rebound | S&P Global Market Intelligence. https://www.spglobal.com/marketintelligence/en/news-insights/blog/wearable-tech-fitness-trackers-on-the-rebound. Accessed 3 Jan 2021.

Greiwe J, Nyenhuis SM. Wearable technology and how this can be implemented into clinical practice. Curr Allergy Asthma Rep. 2020;20(8):36. https://doi.org/10.1007/s11882-020-00927-3.

Ringeval M, Wagner G, Denford J, Paré G, Kitsiou S. Fitbit-based interventions for healthy lifestyle outcomes: systematic review and meta-analysis. J Med Internet Res. 2020;22(10):e23954. https://doi.org/10.2196/23954. https://www.jmir.org/2020/10/e23954.

McCallum C, Rooksby J, Gray CM. Evaluating the impact of physical activity apps and wearables: interdisciplinary review. JMIR mHealth uHealth. 2018;6(3):e58.

Zuckerman O, Gal-Oz A. Deconstructing gamification: evaluating the effectiveness of continuous measurement, virtual rewards, and social comparison for promoting physical activity. Pers Ubiquit Comput. 2014;18(7):1705–19.

21% of Americans use a smart watch or fitness tracker | Pew Research Center. https://www.pewresearch.org/fact-tank/2020/01/09/about-one-in-five-americans-use-a-smart-watch-or-fitness-tracker/. Accessed 16 Jan 2021.

Shcherbina A, Mattsson CM, Waggott D, et al. Accuracy in wrist-worn, sensor-based measurements of heart rate and energy expenditure in a diverse cohort. J Pers Med. 2017;7(2):3. https://doi.org/10.3390/jpm7020003.

O’Brien E. Ambulatory blood pressure measurement: the case for implementation in primary care. Hypertension. 2008;51(6):1435–41. https://doi.org/10.1161/HYPERTENSIONAHA.107.100008.

Pickering TG, Miller NH, Ogedegbe G, et al. Call to action on use and reimbursement for home blood pressure monitoring: a joint scientific statement from the American Heart Association, American Society of Hypertension, and Preventive Cardiovascular Nurses Association. Hypertension. 2008;52(1):10–29. https://doi.org/10.1161/HYPERTENSIONAHA.107.189010.

Whelton PK, Carey RM, Aronow WS, et al. 2017 ACC/AHA/AAPA/ABC/ACPM/AGS/APHA/ASH/ASPC/NMA/PCNA guideline for the prevention, detection, evaluation, and management of high blood pressure in adults: a report of the American College of Cardiology/American Heart Association Task Force on clinical practice guidelines. Hypertension. 2018;71(6):1269–324. https://doi.org/10.1161/HYP.0000000000000065.

CMS expands Medicare coverage of blood pressure monitoring device. https://www.modernhealthcare.com/medicare/cms-expands-medicare-coverage-blood-pressure-monitoring-device. Accessed 16 Jan 2021.

Hall AK, Cole-Lewis H, Bernhardt JM. Mobile text messaging for health: a systematic review of reviews. Annu Rev Public Health. 2015;36:393–415. https://doi.org/10.1146/annurev-publhealth-031914-122855.

Dang S, Karanam C, Gómez-Orozco C, Gómez-Marín O. Mobile phone intervention for heart failure in a minority urban county hospital population: usability and patient perspectives. Telemed J E Health. 2017;23(7):544–54.

Nundy S, Razi RR, Dick JJ, Smith B, Mayo A, O’Connor A, Meltzer DO. A text messaging intervention to improve heart failure self-management after hospital discharge in a largely African-American population: before-after study. J Med Internet Res. 2013;15(3):e53.

Hirshberg A, Downes K, Srinivas S. Comparing standard office-based follow-up with text-based remote monitoring in the management of postpartum hypertension: a randomised clinical trial. BMJ Qual Saf. 2018;27(11):871–7. https://doi.org/10.1136/bmjqs-2018-007837.

Miller EC, Zambrano Espinoza MD, Huang Y, et al. Maternal race/ethnicity, hypertension, and risk for stroke during delivery admission. J Am Heart Assoc. 2020;9(3):e014775. https://doi.org/10.1161/JAHA.119.014775.

Bush J, Barlow DE, Echols J, Wilkerson J, Bellevin K. Impact of a mobile health application on user engagement and pregnancy outcomes among Wyoming Medicaid members. Telemed J E Health. 2017;23(11):891–8. https://doi.org/10.1089/tmj.2016.0242.

Kichloo A, Albosta M, Dettloff K, et al. Telemedicine, the current COVID-19 pandemic and the future: a narrative review and perspectives moving forward in the USA. Family Med Commun Hlth. 2020;8(3):e000530. https://doi.org/10.1136/fmch-2020-000530.

Telehealth continues rapid growth amid coronavirus pandemic | healthiest communities | US News. https://www.usnews.com/news/healthiest-communities/articles/2020-07-13/telehealth-continues-rapid-growth-amid-coronavirus-pandemic. Accessed 23 Jan 2021.

Schifeling CH, Shanbhag P, Johnson A, et al. Disparities in video and telephone visits among older adults during the COVID-19 pandemic: cross-sectional analysis. JMIR Aging. 2020;3(2):e23176. https://doi.org/10.2196/23176. Schifeling et al. investigated whether there are important differences between telephone and video visits in a geriatric cohort. The authors showed that video visits were 7 min longer, and had 1.2 more visit diagnoses but similar rates of advance care planning. Also, non-white patients, patients who needed interpreter services, and patients on Medicaid were less likely to have video visits when compared to white patients.

Some Americans can’t access telemedicine, study shows | Doctors Lounge. https://www.doctorslounge.com/index.php/news/hd/99851. Accessed 23 Jan 2021.

Eberly LA, Kallan MJ, Julien HM, et al. Patient characteristics associated with telemedicine access for primary and specialty ambulatory care during the COVID-19 pandemic. JAMA Netw Open. 2020;3(12):e2031640. https://doi.org/10.1001/jamanetworkopen.2020.31640. Eberly et al. investigated which sociodemographic factors are associated with telemedicine use and video visits during the COVID-19 pandemic. The authors found that in a cohort of 148,402 patients, older age, Asian race, non-English language, and Medicaid were associated with fewer completed telemedicine visits. The authors also found that older age, female gender, Black race, LatinX ethnicity, and lower household income were associated with lower video use.

Rodriguez JA, Betancourt JR, Sequist TD, Ganguli I. Differences in the use of telephone and video telemedicine visits during the COVID-19 pandemic. Am J Manag Care. 2021;27(1):21–6. https://doi.org/10.37765/ajmc.2021.88573. Rodriguez et al. performed a cross-sectional study to determine patient and neighborhood characteristics associated with visit modality. The authors found that patients who were older, Black, Hispanic, Spanish-speaking, and from areas with low broadband access were less likely to use video visits. Additionally, they found that clinicians and practices contributed to the disparity more than patients.

Nouri S, Khoong EC, Lyles CR, Karliner L. Addressing equity in telemedicine for chronic disease management during the COVID-19 pandemic | Catalyst non-issue content. NEJM Catalyst. 2020.

Crawford A, Serhal E. Digital health equity and COVID-19: the innovation curve cannot reinforce the social gradient of health. J Med Internet Res. 2020;22(6):e19361.

53% of Americans say internet has been essential during COVID-19 outbreak | Pew Research Center. https://www.pewresearch.org/internet/2020/04/30/53-of-americans-say-the-internet-has-been-essential-during-the-covid-19-outbreak/. Accessed 23 Jan 2021.

Verghese A, Charlton B, Kassirer JP, Ramsey M, Ioannidis JPA. Inadequacies of physical examination as a cause of medical errors and adverse events: a collection of vignettes. Am J Med. 2015;128(12):1322-4.e3. https://doi.org/10.1016/j.amjmed.2015.06.004.

Downes MJ, Mervin MC, Byrnes JM, Scuffham PA. Telephone consultations for general practice: a systematic review. Syst Rev. 2017;6(1):128. https://doi.org/10.1186/s13643-017-0529-0.

Shaw J, Brewer LC, Veinot T. Recommendations for health equity and virtual care arising from the COVID-19 pandemic: narrative review. JMIR Form Res. 2021;5(4):e23233. Shaw et al. performed a review addressing how health equity was impacted on the rapid increase in telehealth use as a result of the COVID-19 pandemic. This review describes recommendations to address issues of health equity on multiple levels: (1) policy and government, (2) organizations and health systems, and (3) communities and patients. From the results of the review, the authors suggest that (1) simplifying user interfaces, (2) using supportive intermediaries, and (3) incorporating and improving marginalized member input are essential strategies to promote health equity in virtual care.

Wood BR, Young JD, Abdel-Massih RC, McCurdy L, Vento TJ, Dhanireddy S, Moyer KJ, et al. Advancing digital health equity: a policy paper of the infectious diseases society of America and the HIV medicine association. Clin Infect Dis. 2021;72(6):913–9. In this policy paper, Wood et al. outline the digital divide and how it relates to the treatment of infectious diseases and human immunodeficiency virus (HIV). The authors recommend that, in order to make telemedicine more accessible for these communities, increased reimbursement, clearer instruction, and expanded language, among other things, are important.