Telehealth is creating health care disparities for patients who are poorer, older and culturally and linguistically diverse, researchers have found.
Telehealth can create extra disadvantage for patients who are poorer, older and culturally and linguistically diverse, researchers have found.
The US study, published in ACR Open Rheumatology, found that non-English language preference was the strongest predictor of low video telehealth use, despite availability of interpreters. Low telehealth take up was also seen in rheumatology patients of a minority race or ethnicity – irrespective of language preference, male sex, low income and increasing age.
“Observed socioeconomic disparities in video visit use may reflect widespread digital care inequities across the US,” study authors said. They called for the causes of low video telehealth use to be identified and addressed to avoid a widening of health care disparities.
The findings align with a recent Australian study that showed how some rheumatology patients, including those who need an interpreter, might not find extra benefit from telehealth and that careful patient selection is key to the successful integration of telemedicine.
The retrospective cohort study examined health record data of around 1500 rheumatology patients, more than half of whom identified as non-white. Consultations for the pre-pandemic year were compared to the 3400 consultations held between April 2020 and March 2021, most of which were via telehealth.
According to the researchers, doctors favour video telehealth to phone-only because it allows for non-verbal communication, visual examination and sharing of images and documents.
Rheumatologist Dr Irwin Lim acknowledges that many of his patients have trouble using telehealth.
“The Department of Health should also commence an education campaign to help patients understand video-based consultation to help ease this transition,” he said.
The proliferation of telehealth in Australia has prompted Dr Lim’s clinics to create and provide an information sheet to patients about using telehealth, and production of a ‘how-to’ video is underway. “I personally prefer video consultations with phone as a back-up,” he said.
The study authors acknowledged the evolving trend towards digital health care and said that delivering equitable health care hinged on clarifying and addressing causes of telehealth disparities. They also noted that the study was limited to the pandemic setting and a relatively small cohort size which could affect generalisability of the findings.
These findings may have implications for the recent culling of MBS items for patient end services which enabled healthcare workers to assist patients during telehealth consultations with specialists.
GP Dr Raymond Wen, co-founder of Telecare Online said that while cutting patient end services is a $5 million saving for MBS, the services are relied on by non-GP specialists when consulting with patients from remote communities, in nursing homes and from linguistically diverse backgrounds.
“Specialists using GPs on the other end to help facilitate telehealth calls add so much to the consultation. Five minutes of the GP’s time to summarise the patient’s history and then another five minutes at the end of the consult to synthesize the examination findings can save so much time,” said Dr Wen.
