Telehealth: Bridging or perpeatuating health inequities?

Health inequities among Black Indigenous People of Color, immigrant and low-income communities is driven largely by inadequate healthcare access. Telehealth offers an opportunity to increase healthcare access and reduce health inequities. However, according to researchers from Boston University Questrom School of Business, Boston University School of Medicine (BUSM), and Boston Medical Center (BMC), telehealth has unwittingly become a “double-edged sword,” whereby the technology with potential to reduce health inequities also holds the key to exacerbate structural inequities.

“Using qualitative data and our own experiences as front line primary care physicians we discovered that while digital access is necessary, it is not sufficient in redressing disparate engagement with telehealth,” says corresponding author Rebecca G. Mishuris, MD, MPH, MS, assistant professor of medicine at BUSM, and primary care physician and Chief Medical Information Officer of the BMC Health System.

According to the researchers, a key component of these structural inequities is the digital divide, driven partly by “digital redlining.” Digital redlining is the modern day manifestation of redlining that perpetuates health inequities and structural racism by maintaining barriers to technological access, further perpetuating lack of healthcare access.

Based on their experience as well as data about their patients’ access to healthcare, virtual and otherwise, Mishuris and her colleagues theorize that two additional barriers to equitable telehealth exist: digital fluency, the ability to use digital tools efficiently and effectively; and the capacity for health advocacy, a patients’ ability to advocate for their own health needs.

“Without addressing these critical, less often discussed elements of telehealth implementation, it is our belief that telehealth will fall short of its promise and rather than mitigate health inequities, will perpetuate health inequities in the very communities that stand to benefit most from its implementation,” says co-author Katherine Gergen Barnett, MD, clinical associate professor of family medicine at BUSM and Vice Chair of Primary Care Innovation and Transformation at BMC.

In an effort to overcome the barriers of device and broadband access, digital fluency and health advocacy to mitigate current inequities in digital health engagement, the researchers propose a three-pronged approach of creating federal and state policies to democratize access to telehealth. “By establishing platform standards for accessing telehealth, and supporting societal and health system investments to increase health literacy, advocacy and technology fluency, we can begin to address the disparities in telehealth engagement and healthcare access,” says Mishuris.

Collaborators include Jayakanth Srinivasan, PhD, research associate professor at Boston University’s Questrom School of Business; Charles T. Williams, MD, BMC/BUSM family medicine; Alexa Bragg, BS, BMC/BUSM family medicine; Afi M. Semenya, MD, MPH, BMC/BUSM family medicine; Marielle Baldwin, MD, MPH, BMC/BUSM family medicine; Jessica Howard, MA, MPH, BMC/BUSM family medicine and Stephen A. Wilson, MD, MPH, BMC/BUSM family medicine.

These findings appear as a Perspective in the Journal of General Internal Medicine.

Funding was provided by the Boston University Center for Antiracist Research.

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