Table 7. Health equity: the digital divide.
| Title | Research design | Time of study | Number of visits/patients | Patient cohort | Findings |
|---|---|---|---|---|---|
| An evaluation of telehealth use by Medicare beneficiaries in 2020 | Retrospective review of Medicare claims data | 1/19–12/20 | ~4.5 million monthly E&M services | 20% random sample of fee-for-service Medicare beneficiaries | • 44% percent of all Medicare beneficiaries received at least one telehealth service in 2020 |
| • 34% of rural residents used telehealth compared to 47% who lived in non-rural zip codes | |||||
| During Pandemic Telemedicine Use: An Analysis of Rural and Urban Safety-Net Clinics | Retrospective review | 3/19–3/21 | 1,016,000 patients | Adult patients who completed at least one telehealth clinic in a safety-net clinic | • Telehealth use in urban areas rose by 52.3% |
| • Patients in rural areas only had a 27.2% increase in use of telehealth | |||||
| Telehealth Use Among Safety-Net Organizations in California During the COVID-19 Pandemic | Retrospective review | 2/19–8/20 | 1,700,000 patients | Adult patients seen in California federally qualified health centers | • For primary care, 48.1% of visits were in person, 48.5% through telephone and 3.4% via video |
| • For behavioral health, 22.8% of visits were in person, 63.3% through telephone, and 13.9% via video | |||||
| OIG 2022 Telehealth Databrief | Retrospective review of Medicare data | 1/20–2/21 | 28 million patients | Medicare patients who used telehealth | • 45% of urban beneficiaries used telehealth |
| • 33% of rural beneficiaries used telehealth | |||||
| • 12.7 million beneficiaries (19%) used audio-only telehealth services | |||||
| • Patients with lower socioeconomic status and Hispanic beneficiaries were more likely to use audio-only services | |||||
| Predictors of Audio-Only Versus Video Telehealth Visits During the COVID-19 Pandemic | Retrospective review | 4/20–6/20 | 104,200 patients | Patients at University of Michigan Health system who had at least one telehealth visit | • 45.4% received care through phone visits only |
| • Older age decreased odds of video telehealth use by 7% for every 10 years of age increase | |||||
| • African American race decreased odds of video telehealth use by 10% | |||||
| • Need for an interpreter decreased odds of video telehealth use by 19% | |||||
| • Medicaid as primary insurance decreased video telehealth use by 12% | |||||
| • Living in a zip code with low broadband access decreased odds of video telehealth by 7% | |||||
| Rapid Transition to Telehealth and the Digital Divide: Implications for Primary Care Access and Equity in a Post-COVID Era | Provider survey | 4/20–6/20 | 1,100 providers | Primary care providers in New York | • 62.2% of providers indicated that most of their services were provided through telehealth during early stages of pandemic |
| • In high social vulnerability index areas, 42% of providers delivered most patient care through telephone services | |||||
| • In low social vulnerability index areas, 24% of providers delivered most patient care through telephone services | |||||
| National Survey Trends in Telehealth Use in 2021: Disparities in Utilization and Audio vs. Video Services | Patient survey | 4/21–10/21 | 808,000 patients | Patients who responded to Census Bureau’s Household Pulse Survey | • Telehealth use rates were ranged from 21% to 27% among most demographic subgroups |
| • Rates were much lower among those who were uninsured (9.4%) | |||||
| • Video telehealth rates were lowest among those without a high school diploma (38.1%), adults ages 65 and older (43.5%), and Latino (50.7%), Asian (51.3%) and Black individuals (53.6%) | |||||
| Association of Adequacy of Broadband Internet Service With Access to Primary Care in the Veterans Health Administration Before and During the COVID-19 Pandemic | Retrospective review | 3/20–6/21 | 6,996,000 veterans | All veterans with outpatient appointment in VHA | • In second quarter of 2020, 1,750,000 primary care telephone encounters took place compared to around 150,000 video encounters |
| • By the second quarter of 2021, telephone encounters dropped to 1,100,000 visits but video visits slowly rose to 200,000 | |||||
| • Patients in areas where broadband speed was classified as inadequate (<25 MB/s) had lowest increase in video visit use throughout the study period |
E&M, evaluation & management; OIG, Office of Inspector General; VHA, Veterans Health Administration; MB/s, megabytes per second.