A new study published in the Journal of the American College of Surgeons sought to take a closer look at the patients who sought surgical consultations in-person and via telemedicine in 2020.  

Between March 24 and June 23, researchers found that Latinx patients were significantly less likely to have video telemedicine compared with audio-only visits. And between June 24 and December 2020, Black patients were more likely to use virtual surgical consultations.  

"The COVID-19 pandemic dramatically transformed the healthcare delivery landscape and fundamentally shifted the ways in which patients access healthcare," wrote researchers.  

"Digital literacy, access to technology, and the ability to effectively communicate with providers through virtual platforms have now become critical social determinants of health," they added.  

WHY IT MATTERS  

Advocates and policymakers have stressed the importance of ensuring that telehealth is accessible to those who need it, especially members of historically marginalized communities.  

During the first part of the pandemic in 2020, which researchers referred to as "Phase I," white patients constituted the majority of both video and audio-only visits.  

Black patients represented 8.8% and 10.2% of video and audio-only visits, respectively, while Latinx patients accounted for 8.8% and 16.1%, respectively. Women were also more likely to have a virtual visit than men. But researchers observed no significant association between race or ethnicity and visit modality during this time period.

From June 24 through the end of the year, referred to as "Phase II," the study showed a different story.  

Researchers found that overall, Black patients were more likely to have virtual visits than white patients, with women again more likely than men to seek surgical consults via telemedicine.  

Older patients, patients with lower education levels and patients with a primary language that is not English were also less likely to use video streaming during virtual visits over this time period.  

The researchers noted that the decrease in video visits among those demographics may reflect the hurdles to telemedicine access for many already vulnerable groups.  

"As the healthcare system shifts to a new normal, the digital divide and structural discrimination against vulnerable groups may continue to impair access to surgical care and create inequities in telemedicine utilization," they noted.  

At the same time the study theorized that telehealth platforms could provide a critical mechanism for patients of color to keep connecting with care during the pandemic.  

Their findings about Black patients, they said, "may reflect institutional efforts to expand digital health access for communities of color, in addition to disproportionate access barriers to in-person care in this population.  

"The decreased logistical barriers to telemedicine participation make this visit modality more feasible for patients with significant time and resource constraints," they added.

Health systems can take a number of steps toward ensuring the benefits of virtual care are fully realized, they said, including pushing for expanded broadband access and reimbursement incentives.  

"Digital literacy training as well as cultural and linguistic inclusivity in mobile health platform development will further help vulnerable patient populations engage with telemedicine," read the study.

THE LARGER TREND  

The data emerging from telehealth patterns amid the pandemic has suggested that virtual care use may be a complicated issue.

For example, a Pew Research Center study in September 2020 found that Black patients were more likely than white patients to use telehealth because of the pandemic – but that pattern wasn't true for people in New York City.

Geographic and economic factors continue to play a role as well. A RAND study from March 2021 found that, overall, pandemic-era telehealth grew most in wealthy and metro areas.  

ON THE RECORD  

"Importantly, telemedicine use patterns continue to evolve during the pandemic. Virtual visit engagement is affected by patient and provider factors, which are influenced by the public health landscape as well as institutional, state and national policies that govern healthcare delivery," wrote the researchers in the JACS study.

Kat Jercich is senior editor of Healthcare IT News.
Twitter: @kjercich
Email: kjercich@himss.org
Healthcare IT News is a HIMSS Media publication.