Use of telehealth devices in primary care varies by age, race and income

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Current iterative uses of telehealth among US patients may vary by age, race and income, according to new findings.

A cross-sectional analysis of telehealth use among U.S. adults from the Penn Medicine Health System suggested that tablets and phones are the most commonly used tools for remote visits and consultations, although the rate of Use differs in younger and older patients as well as those of different races and ethnicities.

The new data could involve the future frontline primary care telehealth strategy, as well as efforts at the public health level to expand the availability of telehealth in different US populations.

A team led by Allison Hare, MD, and Eric Bressman, MD, MSHP, from the Perelman School of Medicine’s Department of Medicine, conducted a study of telehealth visits held at a Penn Medicine primary care practice during the pandemic. of COVID-19. The team sought to interpret the variability of devices used by patients based on demographics, noting that previous research lacked such context despite the growing emphasis on remote care practice.

“Given the increase in the use of telehealth during the COVID-19 pandemic, concerns exist about unequal access to telehealth among disadvantaged populations,” they wrote. “Efforts to improve access to telehealth can be aided by a better understanding of how patients access these visits.”

The team identified adults ≥18 years old who had ≥1 telehealth visit between December 9, 2020 and September 30, 2021 at the primary care practice. They assessed each observed patient’s self-reported race and ethnicity, as well as postal code-based median household income data based on electronic health records.

A multivariate logistic regression model using generalized estimating equations was used to analyze the link between patient demographics and the use of telehealth tools such as phones, tablets, computers or laptops. Hare and Bressman also reported odds ratios (ORs) to compare the use of each device based on patient demographics.

The final analysis included 55,812 adult patients who had ≥ 1 office telehealth visit. Of these, 41.6% (n=23,243) used a desktop or laptop computer for their visit, while 58.4% (n=32,569) used a phone or tablet.

White patients were significantly less likely than black patients to use a phone or tablet during their visit (OR, 0.44; 95% CI, 0.36, 0.52), as were non-Hispanic patients and non-Latino compared to Hispanic or Latino patients (OR, 0.73; 95% CI, 0.66, 0.81).

Investigators further observed less phone or tablet use in adults ≥80 years old compared to 18-29 year olds (OR, 0.79; 95% CI, 0.68 – 0.91) as well as in those with higher median income by postcode, compared to lower median income (OR, 0.79; 95% CI, 0.70 – 0.90).

Hare, Bressman and colleagues have pointed out that these observed disparities in telehealth could benefit and adapt strategies to strengthen the availability of telehealth in the United States.

“Desktop or laptop usage depends on wired broadband access, while smartphones and many tablets can use either wired or wireless broadband,” they wrote. “Our findings suggest that beyond the recent major federal investment in wireline broadband, other opportunities (e.g., financial support for cellular data plans, expansion of 5G networks in underserved communities) can help patients access telehealth services.

They called for future interventions that could “bridge the digital divide”, such as further analysis of what type of telehealth device is used by which patients.

The study, “Association between patient demographics and devices used to access telehealth visits in a primary care network in the United States,” was published online in JAMA Health Forum.

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