Telehealth, a key part of pandemic-era care, should be more accessible for more patients

A study by the UCLA Latino Policy and Politics Institute found that since COVID-19 emerged, language barriers have prevented Latino and Asian patients in Los Angeles from making full use of telehealth services.

The research also revealed that Black and white patients had greater ease with video visits — and that some older patients and those with limited access to technology, particularly Latinos, relied on family members to help them access telehealth services.

The study is based on data from a Los Angeles County health care system: Researchers analyzed patient visits from January through December 2020 and conducted surveys and interviews with 39 health care providers at seven of the health system’s clinics between August 2021 and April 2022.

The findings underscore the need for care providers to take into account the roles that patients’ race, ethnicity, age and primary language play in how telehealth services are adopted.

This study is timely because in July 2022, the US House of Representatives approved a bill to extend Medicare reimbursements for telehealth visits through the end of 2024, and the US Senate is currently considering legislation that would direct more funding for telehealth visits to Medicare beneficiaries.

Improving how telehealth services are deployed could help address the longstanding inequities in access to and use of health care services that communities of color have faced, said Arturo Vargas Bustamante, a professor of health policy and management at the UCLA Fielding School of Public Health and director of faculty research at the Latino Policy and Politics Institute.

“For patients who may avoid medical appointments because of scheduling, the loss of wages or transportation challenges, telehealth offers an option to receive health care without leaving their home or workplace,” Bustamante said. “Our study found that while language and technological barriers persist, a hybrid approach, combining in-person and telehealth visits, has the potential to improve both the patient and provider experience.”

Other findings include:

  • Health care providers of color were more likely than white providers to report that patients’ race and ethnicity affected their use of telehealth services.
  • The share of telehealth visits increased from 8% prior to the pandemic to nearly 48% almost immediately after California’s stay-at-home order went into effect in March 2020, demonstrating that telehealth appointments were critical in helping patients receive care, even when they were unable to go to the clinic.
  • Telehealth appointments by phone (more than 80%) were much more common than video telehealth appointments. The percentage of patients who used video appointments varied by race and ethnicity.
  • Patients continued using telehealth for health enhancement purposes — wellness and nutritional care classes, for example — even as pandemic restrictions eased in the second half of 2020.

“The pandemic is a crisis that forced innovation in how to better provide health care, and as telehealth continues to be a significant way of receiving care, it will be important to make sure that no one, regardless of their age, race, ethnicity or language spoken, is left behind,” said Diana Camacho, senior program officer for the California Health Care Foundation, which funded the study.

The study’s authors recommend that health care systems and providers address the digital literacy and technology barriers that patients face by investing in programs that provide technology support, both in person and remotely, to people who have trouble navigating telehealth on their own. Furthermore, providers should support efforts to allocate technology devices and internet services to their patients.

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