The COVID-19 pandemic has sparked a surge in telehealth technology as healthcare providers find ways to help patients without having to visit a doctor in person. However, wider adoption of the technology also increases the potential for new and different types of health care inequalities.
in a new report Journal of General Internal MedicineVeterans Health Administration (VHA) staff has released a list of priorities for researchers as they begin examining actual and potential inequities in telehealth.
As certain communities have been disproportionately affected, the pandemic has exposed significant disparities within the U.S. healthcare system, the study authors noted. One of the ways healthcare providers have sought to reach patients during this time has been through telehealth, but the researchers say this shift has opened up new potential differences. For example, they say certain populations rely more on audio-only telemedicine than video-based services.
“In the post-pandemic era, virtual care is likely to remain an important component of ambulatory care, so it is critical to ensure that the design and implementation of virtual care does not exacerbate current inequalities in access and health outcomes,” the investigators said.
They decided to convene a think tank of VHA’s clinicians, researchers and operating partners to identify future research needs and priorities with a view to eliminating telehealth-related inequities and promoting a TechQuity. This strong team of 43 members comes from a variety of locations, backgrounds and VHA offices. They ultimately selected 4 priorities that they felt were the most important in addressing telehealth inequities.
The first is figuring out how best to measure inequities in virtual care. In this regard, they say next steps should include regular collection of data related to social determinants of health and the creation of virtual care health equity indicators, among other steps.
Second, the team says, investigators should prioritize identifying ways to address emerging inequities in virtual care. This task will require a comprehensive assessment of available telehealth resources and the barriers to patient access to them. The authors write that the trust levels and preferences of different populations also need to be examined to ensure that telemedicine resources are deployed in a manner that meets the needs of different populations.
Third, investigators say it is important to identify accommodations to ensure that people with vision, hearing, cognitive and physical disabilities have equal access to virtual care. To achieve this, they said investigators should work closely with leading advocacy groups such as Paralyzed Veterans of America and Disabled American Veterans.
Finally, the authors say a fourth priority is to examine potential adverse consequences of expanding virtual care. Potential problems include delayed diagnosis or reduced preventive care, provider burnout and system-level inequities, they said.
“The use of virtual care as an alternative represents a fundamentally different application of the technology; therefore, there is uncertainty about the potential benefits and harms,” they wrote.
They concluded that health equity must be at the heart of future deployments of telehealth services. However, turning this hope into reality will require a deep understanding of the possible impact of virtual care, as well as coordination among a broad range of stakeholders, they say.
“While there is still much work to be done, the priorities identified by our think tank represent an important step towards enabling TechQuity of virtual care at the VHA,” they emphasize.
Walsh C, Sullivan C, Bosworth HB, et al. Integrating technology into virtual care at the Veterans Health Administration: Identifying future research and operational priorities. J Gen Intern Med. 2023;1-9. doi:10.1007/s11606-023-08029-2