Health Disparities
Telemedicine was implemented rapidly in 2020 due to COVID-19. While telemedicine improves access and reduces barriers to healthcare access for many, several barriers and challenges remain for many. With the explosion of telehealth has come a digital divide and increased growth in health disparities.
Telehealth, or telemedicine, is the ability of a patient to receive medical care services via electronic information and telecommunication technologies. Just as in traditional medicine, medical inequities exist in telehealth. Research indicates that patients facing inequities in healthcare in rural areas have received better healthcare access with telehealth (Khairat et al., 2021). This is good news for those in rural areas if they have access to telehealth and IF they understand how to use it. Research indicates that that there are issues of disparity in telehealth that range from the digital divide to numerous health literacy issues.
There have been billions of dollars spent to overcome the digital divide, and there has been some success, but people in rural areas still have poorer outcomes than those in urban areas where there is more access to medical intervention (Sharby, Martire, & Iversen, 2015). Multiple barriers in rural health are not found in urban health, such as digital health literacy. Digital Literacy is defined as how well people can navigate the digital world, which is shaped by demographic profile, education levels, political tolerance, degree of skepticism about news sourced from social media.
Vulnerable populations of the rural areas include patients who are racial or ethnic minorities, children, elderly, socioeconomically disadvantaged and underinsured or those with certain medical conditions. (Bolin et al., 2015), these are the same populations that have low ehealth or digital health literacy.
We now know the benefits of Telehealth to all individuals that use it. However, there is scarce research to address those individuals who have access to telehealth, including those individuals in rural areas as to why they do not use telehealth. If billions of dollars are being spent to decease the digital divide there should be a similar investment to find out why people who have access are avoiding the use of telehealth when research indicates it could help improve health outcomes. Do these individuals that do not use telehealth have an adequate alternative to telehealth and always received medial are when needed? Could telehealth augment their health care? These are important questions to answer but first we need to know if ehealth literacy is a part of this problem before spending more money in fixing a system that can’t be used by those who don’t understand it.
In the time of COVID-19 and beyond, telemedicine can no longer be considered a "complement" to in-person care. Telemedicine should be seen as an "alternative" for in-person healthcare (Gilbert, Billany, & Adam, 2020). Evidence regarding disparities that manifest through telemedicine can be used to inform tool design and systemic efforts to promote digital health equity. (Chunara et al., 2021).
Being equipped with the skills to navigate and utilize the Internet are critical for meaningful broadband adoption. If individuals cannot take advantage of the resources the Internet has to offer, having a connection at home still will not yield its full benefits and value. Moreover, as networks and technology become more ubiquitous, digital literacy will be required for full inclusion into society. The Digital divide is an important factor in Telehealth participation, but eHealth Literacy is the key
References
Bolin, J. N., Bellamy, G. R., Ferdinand, A. O., Vuong, A. M., Kash, B. A., Schulze, A., & Helduser, J. W. (2015). Rural Healthy People 2020: New Decade, Same Challenges. The Journal of rural health : official journal of the American Rural Health Association and the National Rural Health Care Association, 31(3), 326–333. https://doi.org/10.1111/jrh.12116
Chunara, R., Zhao, Y., Chen, J., Lawrence, K., Testa, P. A., Nov, O., & Mann, D. M. (2021). Telemedicine and healthcare disparities: a cohort study in a large healthcare system in New York City during COVID-19. Journal of the American Medical Informatics Association : JAMIA, 28(1), 33–41. https://doi.org/10.1093/jamia/ocaa217
Federal Communications Commission (2017). Strategies and Recommendations for Promoting Digital Inclusion. Consumer and Governmental Affairs Bureau Federal Communications Commission, DOC-342993A1.pdf
Gilbert, A.W., Billany, J.C.T., & Adam, R. (2020). Rapid implementation of virtual clinics due to COVID-19: report and early evaluation of a quality improvement initiative. BMJ Open Quality, 9(2). https://doi.org/10.1136/bmjoq-2020-000985.
Khairat, S., Haithcoat, T., Liu, S., Zaman, T., Edson, B., Gianforcaro, R., & Shyu, C. (2019). Advancing health equity and access using telemedicine: a geospatial assessment. Journal of the American Medical Informatics Association: JAMIA, 26(8–9), 796–805. https://doi.org/10.1093/jamia/ocz108.
Sharby, N., Martire, K., & Iversen, M. D. (2015). Decreasing health disparities for people with disabilities through improved communication strategies and awareness. International Journal of Environmental Research and Public Health, 12(3), 3301–3316. https://doi.org/10.3390/ijerph120303301
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