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Digital health equity
The meteoric rise of telemedicine in response to the COVID-19 pandemic and the need to social distance elevates the importance of addressing patient care-gaps, especially for groups already disproportionately burdened by the digital divide.
Disparities in Use of Video Telemedicine Among Patients With Limited English Proficiency During the COVID-19 Pandemic
Telemedicine expands health care access for patients facing barriers to in-person care but may also inadvertently widen existing care disparities for the 25 million people living in the US with limited English proficiency (LEP). In this large, diverse sample of patients seeking primary care during the COVID-19 pandemic, one-third of patients with LEP scheduled a visit by video instead of telephone. Patients with LEP chose video less often than patients without LEP, but, among patients with video visit experience, no significant difference in video visit use by LEP was found, suggesting that once patients with LEP have video visit use experience, they are not different from patients without LEP in likelihood to reuse video visits.
Cross-sectional Associations of Patient Language and Patient-Provider Language Concordance with Telemedicine Choice Among Adults with Limited English Proficiency
With reduced barriers to seeking out a language-concordant provider, we examined associations of patient language and patient-provider language concordance (i.e., speaking the same language) with telemedicine visit type (video or phone visit). Compared to patients speaking Spanish, video visit use was higher among patients speaking Cantonese, Mandarin, and Vietnamese, but lower among those speaking Punjabi. Interestingly, video visit use was lower among those who shared the same language as their provider. It’s possible that those who do not speak the same language as their provider rely on the visual cues video visits afford.
Association of Medical Assistant-Supported Virtual Rooming With Successful Video Visit Connections
This study evaluated factors associated with successful video visit connections in a hospital system with 4.5 million members. We found that medical assistant–supported virtual rooming (i.e., connecting with the patient before the physician connects) was associated with successful video visit connections in this diverse population. High medical assistant rooming rates were associated with better connection improvements for patients at higher risk of not connecting, including those with lower SES, of Latino ethnicity or African American or Black race, or those needing interpreters. Medical assistant–supported virtual rooming merits further testing as a possible means of narrowing the digital divide.
Strategies Facilitating Video Visit Implementation by a Medical Group Serving a Diverse Population
In this qualitative study, we interviewed hospital leaders, primary care physicians, service managers, and medical assistants about the strategies used to facilitate the successful delivery of video visits to populations negatively impacted by the digital divide. Key strategies for sustained video care adoption included clinical leadership articulating its purpose, multidisciplinary collaboration, local innovation, effective data use, empathy, and personalized care. These findings provide a model for how health care systems can foster robust adoption of technologies in a more equitable way.
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