Telemedicine has made it easier for patients to access care, but as the adoption of this technology has expanded exponentially in the age of COVID-19, it’s now more important than ever for clinicians to be able to deliver virtual care in an inclusive way.
While there are a number of positive impacts telemedicine can have on inclusive care—overcoming distance, better scheduling options, making more mental health resources available, and reducing costs—health care providers need to make sure they practice telemedicine in a way that doesn’t perpetuate existing health inequities.
What are the barriers to making telemedicine inclusive?
It’s important to first consider the potential roadblocks that patients may encounter when trying to access virtual care. Here are a few of the most common barriers:
- Telemedicine can alienate non-English speakers. Having limited English language proficiency is already a major barrier for in-person clinical visits, so it’s no surprise that it’s repeated for patients who are using telemedicine. According to a 2022 study of community health centers, third-party translation services were difficult for patients to integrate into their video visits since it required calling interpreters to conference them into Zoom. The setup information and FAQs for the Zoom application were also only available in English or poor translations. Ultimately, bilingual care delivery team staff were essential for providing efficient telemedicine experiences.
- Telemedicine requires a device, good internet connection, and a baseline of digital literacy. Many of us use the internet on digital devices with such regularity that we take it for granted as a resource, but there are a number of communities in the U.S. who don’t have the same access. According to studies conducted by the Pew Research Center, it’s estimated that at least 1 in every 4 Americans may not have digital literacy skills or access to internet-enabled digital devices needed for telemedicine appointments.
- Some patients require in-person assistance. In certain cases involving patients with complex clinical needs, or when symptoms could be caused by a number of issues, a hands-on physical examination is the only way to get an accurate diagnosis.
How telemedicine can improve inclusive care.
Telemedicine has created new opportunities for certain communities historically underserved by health care.
- LGBQ and TGNC people face discrimination. LGBTQIA+ people who live in rural settings and/or places without inclusive health care providers can access therapy, prescription management, HIV and AIDS education and support, and gender-affirming care all via telemedicine visits, without having to face stigma and discrimination.
- Older adults can experience many roadblocks. For adults age 65 and over, telemedicine may require some digital literacy training, but it can be extremely beneficial for routine doctor visits. Aside from limiting the exposure to COVID-19, not having to secure transportation for every appointment makes things much easier for patients and their families, especially for individuals with limited mobility.
- BIPOC communities can find greater access with telehealth. Telehealth can make follow-up care more accessible, by overcoming barriers to access, transportation, and time off from work. For Black patients in Philadelphia, telemedicine improved post-discharge primary care visit completion rates from from 52% to 70% in 2020.
- People in low-resource communities deserve better. Individuals living in health care deserts and/or places with clinician staffing shortages, can access virtual health care when in-person care is not an option. This is especially beneficial for those seeking consultations with specialists and mental health care providers.
How clinicians can make telehealth inclusive.
Addressing health disparities requires care delivery teams to practice through an equitable lens, both in-person and via virtual visits with patients. Here are some tips you can implement for your telehealth delivery:
- Open a dialogue. Ask your patients about any barriers they have about using telemedicine. It could be as obvious as not owning a digital device, or more subtle attitudes towards virtual care in general. By doing this, you can screen each individual for their digital literacy, what access they have to devices and the internet, and any social determinants of health that impact their situation and attitude.
- Clearly explain telehealth as an extension of care. Make sure your patients understand that virtual visits are offered as an addition to in-person care—not as a replacement for face-to-face clinical interactions.
- Provide technical support on both sides. Patients may need ongoing assistance setting up and accessing their telemedicine applications, and as noted earlier, this information should be accessible in languages other than English. It’s also crucial for care delivery staff to be trained in best practices for video visits, both for technical proficiency, as well as video “bedside manner.”
- Use applications that support the use of third-party interpreters. Adopting a sustainable translation solution for virtual care can take the burden off of the patient as well as your staff.
- Proactively plan to reduce clinician burnout. While telemedicine has helped mitigate the symptoms of physician burnout by offering more flexibility and autonomy, “Zoom fatigue,” adopting new electronic health record systems, and navigating new billing and reimbursement codes can bring on mental exhaustion. Make sure that telehealth workflows support your whole care delivery team.
- Connect patients to local resources. Whether it’s information regarding reduced-cost broadband, digital hubs supported by libraries or community groups, or digital training programs, having a list of local resources can be extremely helpful to patients.
- Advocate for changes to policy that make the internet an essential free or low-cost service. Support programs like the Affordable Connectivity Program (ACP), Emergency Connectivity Fund, and the E-Rate Program for schools and libraries, which are working toward making broadband more affordable and making digital devices more accessible.
- Stay flexible. Building a one-size-fits-all approach to telemedicine won’t support your most vulnerable patients in the long run. Have a backup plan for individuals who have difficulty accessing video visits, and make sure non-clinical staff are set up to troubleshoot technical issues, ideally prior to a patient’s appointment.
- Cultural competence is key to better telemedicine outcomes. When patients feel more comfortable with their health care provider, either because of a shared identity, or because the clinician is actively practicing cultural humility, they are more likely to adhere to treatment recommendations.
As telehealth continues to expand, we should keep inclusivity as a top priority, and ensure all communities have access to this evolving technology. Telemedicine has the potential to address long standing health inequities, but that’s only possible by being mindful of the needs of each individual patient.
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