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Patients from disadvantaged communities were less likely to have access to telemedicine during the pandemic, a new study shows.
Ophthalmologists at the Massachusetts Eye and Ear clinic in Boston analyzed patient demographics in 2020, finding that black patients, non-English speakers, and those who didn't attend college were less likely to access care through telemedicine.
In addition, patients who were older, less educated, unemployed, retired, or had a disability were more likely to seek telephone-based visits rather than video-based visits.
'Implementation of telemedical care does not necessarily improve access to care for all populations, and overreliance on telemedicine using current approaches may inadvertently increase health disparities,' the team said.
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Telemedicine has become popular during the pandemic as a way for doctors to see patients without putting them at risk for COVID-19.
In a telemedicine visit, a patient talks to their doctor through a video or phone call instead of going to the doctor's office in person.
This practice was particularly well-utilized in spring 2020, when many state and local leaders instituted stay-at-home orders and health clinics cancelled nonessential medical services.
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But telemedicine was easier to access for some patients than others.
Low-income, minority and other disadvantaged populations may be less likely to have a smartphone, computer, Wi-Fi, or the technological knowledge needed to attend a telemedicine appointment.
A new study from ophthalmologists provides additional evidence for this trend.
The study - published Thursday in JAMA Ophthalmology - also included contributions from eye doctors at Johns Hopkins, Harvard, and New York University.
The ophthalmologists analyzed all patient appointments at the Massachusetts clinic between January 1 and December 31, 2020.
As the state went on lockdown in spring 2020, the clinic's policy was to use video visits whenever possible and to talk to patients over the phone if video wasn't available.
In total, the clinic had about 2,300 telemedicine visits in 2020, including 1,900 patients.
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Demographics of the telemedicine patients reflected disparities in access to this service, the researchers found.
For example: black patients were 0.69 times as likely to have a telemedicine visit as white patients.
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Non-English speakers were 0.63 times as likely to have a telemedicine visit as those who spoke English as their first language.
Patients who didn't go to college were 0.83 times as likely to have a telemedicine appointment as those with postgraduate education.
And men were less likely to have telemedicine appointments compared to women - 0.86 times as likely.
The researchers also found that older patients were less likely to receive telemedicine care.
The median age for telemedicine patients was 61, compared to a median of 63 for patients who received care in-person.
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If an older patient did have a telemedicine appointment, they were more likely to do it over the phone, the analysis showed.
Patients who didn't go to college were also more likely to have telemedicine visits over the phone - compared to over video - as well as those who were retired, unemployed, and disabled.
Most of the telemedicine patients had received care at the clinic before - just 22.3 percent of the patients were new to the clinic.
Established patients were more likely to be older adults, suggesting that older patients might be less likely to seek out a new doctor or new diagnosis via telemedicine.
Telemedicine was most popular in spring 2020, aligning with stay-at-home policies in Massachusetts.
The clinic saw its highest number of telemedicine visits in May: 181 visits in the week of May 10.
In early June, the clinic announced its reopening plan - leading to a decline in telemedicine visits, followed by a plateau at the end of August.
Some patients opted to continue using telemedicine through the end of 2020.
This study aligns with other research showing that telemedicine can make it harder for already-disadvantaged populations to access healthcare.
'Our findings highlight the fact that implementation of telemedical care does not necessarily improve access to care for all populations, and overreliance on telemedicine using current approaches may inadvertently increase health disparities for historically marginalized populations,' the researchers wrote.
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Other studies show that black patients, low-income patients, and those who live in rural areas are less likely to utilize telemedicine.
The barriers for these patients may include a lack of internet access or access to electronic devices, as well as lower technology and health literacy, the researchers said.
This trend may also be seen in disadvantaged patients' preference for phone over video visits - as phone visits are easier to attend and don't require internet access.
This study was retrospective - looking back at patients' medical records - and focused on one clinic in Massachusetts.
Clinics in other parts of the country may have had different trends, the researchers said.
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