Tech difficulties pose telehealth barriers for patients of color

A systematic review of 28 studies published in the Journal of the American Medical Informatics Association this week found that telehealth-delivered interventions for patients of color were mostly effective when it came to treating and managing many conditions.

However, technological difficulties were the main barriers to effective telehealth consultation.  

The study, led by researchers from Monash University in Victoria, Australia, sought to examine the effectiveness of telehealth for non-Indigenous patients of color.  

“Findings from this systematic review indicate that telehealth for mental health and some physical health conditions … [offers] promise across a range of outcomes and healthcare settings and can result in high levels of patient satisfaction,” wrote the researchers.

“However, it is yet to be determined whether this translates to other healthcare settings, different health conditions, and other racial/ethnic minority populations (particularly in countries outside the United States),” they said.  

WHY IT MATTERS

Researchers found that 14 studies measured health outcomes, with evidence of effectiveness of telehealth on measures of mental health, cardiovascular health and diabetes-related results.  

Sixteen found that most patients, caregivers and providers were satisfied with telehealth consultations.  

And patients of color reported that virtual care improved access to services in a variety of ways. Still, the studies pointed to challenges, such as technology hurdles, patient anxiety and structural barriers to care.  

“The cultural appropriateness and acceptability of telehealth consultations and development of cultural frameworks to guide telehealth use should be considered more broadly, particularly if services are being delivered transnationally,” noted researchers.  

The review also flagged key limitations of existing research, given the increasingly widespread adoption of telehealth across the industry.  

“In this review, studies with African American populations are underrepresented relative to other minorities, potentially reflecting a greater focus on issues related to language by existing research,” researchers wrote.  

Importantly, the researchers chose not to include Indigenous peoples in their review because of what they referred to as the unique health needs stemming from colonization, dispossession, genocide and forced removal from lands.  

“As First Nations peoples, Indigenous communities are the original inhabitants of their country,” they wrote. “Importantly, the strength, resilience and advocacy of Indigenous peoples, as evident in community-controlled health services in some countries, has led to different healthcare systems and supports. 

“These address the social determinants of health and political advocacy, as well as clinical interventions to treat disease,” they continued. “Issues related to health equity experienced by Indigenous peoples and their community-based responses to these issues are therefore different from non-Indigenous racial [and] ethnic minorities.”  

They pointed to other studies that suggest telehealth can improve access to healthcare among Native and Indigenous groups, along with identifying barriers and enablers.  

THE LARGER TREND  

Several studies have sought to examine the use and efficacy of telehealth among patients of color.  

Some research has found that Black and Latinx patients in New York City were less likely than white patients to use telehealth during the early pandemic, while others say Black surgical patients used telehealth more often than white patients in late 2020.

Clearly, as the Monash researchers note, more investigation is warranted.   

Organizations have also stressed the importance of ensuring telehealth adoption doesn’t widen the existing digital divide, particularly from a connectivity perspective.  

“There’s still a have and have-not system when it comes to broadband,” said Mignon Clyburn, former commissioner at the Federal Communications Commission, at the American Telemedicine Association’s EDGE policy conference in February 2021.

And when people don’t have access to quality internet, said Clyburn, “that further hampers their access to quality telehealth care.”

ON THE RECORD  

“Addressing structural … and system … barriers to telehealth use will improve the accessibility and equity of health systems and increase engagement among racial/ethnic minority groups and other underserved groups,” wrote the research team in JAMIA regarding their study.

Kat Jercich is senior editor of Healthcare IT News.
Twitter: @kjercich
Email: kjercich@himss.org
Healthcare IT News is a HIMSS Media publication.