Patients from disadvantaged communities were less likely to access telemedicine during the pandemic, a new study shows.
Ophthalmologists at the Massachusetts Eye and Ear Clinic in Boston analyzed patient demographics in 2020 and found that black patients, non-English speakers, and those not attending college were less likely to access care through telemedicine.
In addition, patients who were older, less educated, unemployed, retired or disabled were more likely to have telephone visits than video-based visits.
“The implementation of telemedical care does not necessarily improve access to care for all populations, and over-reliance on telemedicine using current approaches may inadvertently increase health disparities,” the team said.
Black patients and people from other disadvantaged communities were less likely to use telemedicine during the pandemic, new study finds
Telemedicine visits peaked in May 2020 and then declined as the clinic reopened in the summer
Telemedicine has become popular during the pandemic as a way for doctors to see patients without putting them at risk for COVID-19.
On a telemedicine visit, a patient talks to their doctor via video or phone call rather than going to the doctor’s office in person.
This practice was put to particularly good use in the spring of 2020, when many state and local leaders instituted stay-at-home orders and health clinics canceled non-essential medical services.
But telemedicine was easier to access for some patients than others.
Low-income, minority, and other underprivileged populations are less likely to have a smartphone, computer, Wi-Fi, or the technological knowledge needed to attend a telemedicine appointment.
A new study of ophthalmologists provides additional evidence for this trend.
The study — published Thursday in JAMA Ophthalmology — also included contributions from ophthalmologists from Johns Hopkins, Harvard and New York University.
The ophthalmologists analyzed all patient appointments at the Massachusetts clinic between January 1 and December 31, 2020.
When the state went into lockdown in the spring of 2020, the clinic’s policy was to use video visits whenever possible and to talk to patients over the phone if video wasn’t available.
In total, the clinic had about 2,300 telemedicine visits in 2020, including 1,900 patients.
The demographics of the telemedicine patients reflected differences in access to this service, the researchers found.
For example, black patients were 0.69 times more likely to have a telemedicine visit than white patients.
Non-English speakers were 0.63 times more likely to receive a telemedicine visit than those who spoke English as their first language.
Patients who did not attend college were 0.83 times more likely to have a telemedicine appointment than those with a postgraduate degree.
And men were less likely to have telemedicine appointments than women — 0.86 times more likely.
Older patients were more likely to make telemedicine appointments by phone compared to younger patients, the researchers found.
The researchers also found that older patients were less likely to receive telemedicine care.
The median age for telemedicine patients was 61, compared with a median of 63 for patients receiving personal care.
If an elderly patient had a telemedicine appointment, they were more likely to do so over the phone, the analysis found.
Patients who didn’t go to college were also more likely to have telemedicine visits over the phone — compared to video — as were those who were retired, unemployed and disabled.
Most telemedicine patients had previously been treated in the clinic – only 22.3 percent of the patients were new to the clinic.
Established patients were more likely to be older adults, suggesting that older patients are less likely to seek a new doctor or new diagnosis through telemedicine.
Telemedicine was most popular in the spring of 2020, in line with Massachusetts’ stay-at-home policy.
The clinic saw the highest number of telemedicine visits in May: 181 visits in the week of May 10.
In early June, the clinic announced its reopening plan – leading to a decline in telemedicine visits, followed by a plateau in late August.
Some patients chose to continue using telemedicine until the end of 2020.
This study joins other research showing that telemedicine may make it more difficult for already disadvantaged populations to access health care.
“Our findings highlight the fact that implementing telemedicine does not necessarily improve access to care for all populations, and over-reliance on telemedicine using current approaches may inadvertently increase health disparities for historically marginalized populations,” the researchers wrote.
Other studies show that black patients, low-income patients and people living in rural areas are less likely to use telemedicine.
The barriers for these patients may be a lack of Internet access or access to electronic devices, as well as lower technology and health literacy skills, the researchers said.
This trend can also be seen in disadvantaged patients’ preference for telephone rather than video visits – as telephone visits are easier to visit and do not require internet access.
This study was retrospective — looking back at patients’ medical records — and focused on one clinic in Massachusetts.
Clinics in other parts of the country may have had different trends, the researchers said.