A new study published this week in the Journal of the American Medical Informatics Association showed that in mid-March, Black people were more likely to self-report telehealth use in response to the novel coronavirus pandemic – particularly when perceiving COVID-19 as a minor threat to their own health.

The Pew Research Center conducted the survey of more than 10,000 people from March 19 through March 24 of this year, asking whether participants "used the internet or email to connect with doctors or other medical professionals as a result of the coronavirus outbreak."

About 17% of respondents said that they had done so, with significantly higher unadjusted odds among Black people, Latino people and other people of color, compared with white people.

"The systemic racism creating health and healthcare disparities has likely raised the need for telehealth among Black patients during the pandemic," wrote the University of Wisconsin, Milwaukee-affiliated researchers in the JAMIA study.

"Findings suggest opportunities to leverage a broadly defined set of telehealth tools to reduce health care disparities post-pandemic," they added.

WHY IT MATTERS

Telehealth use has grown astronomically since the coronavirus began to spread around the country this spring, with mid-March acting as an inflection point of sorts for major change. This was aided, in part, by federal moves to ease regulations around telehealth reimbursement and use throughout the United States.

Still, despite the advancements in access, many stakeholders have raised concerns about the reliance on telehealth deepening the healthcare divide that puts people of color at heightened risk for medical issues. 

"Innovations in health care policies and technologies risk reproducing and even exacerbating existing inequalities due to systemic racism, making it less likely that members of racial and ethnic minority groups can benefit," wrote the study authors.

The authors also noted that people of color, especially Black people, are at a disproportionately high risk of contracting a COVID-19 infection and dying from it. 

"In turn, their exposure to the virus potentially prompts them to search for channels like telehealth to receive medical advice about symptoms consistent with an infection," they wrote.

For this study, researchers conducted a secondary analysis of nationally representative survey data from the Pew Research Center of U.S. adults with Internet access. Respondents had the opportunity to self-identify as "white, Black, Latino, or other" in the survey, with no opportunity to choose multiple options. They were also asked "How much of a threat, if any, is the coronavirus outbreak for your personal health?"

About 65% of the sample identified as white, with 10% as Black, 16% as Latino and 9% as another race. Roughly one-fifth were older than 65, with a plurality of respondents (35.6%) between the ages of 30 and 49, and about one-quarter between the ages of 50 and 64.

The majority of respondents perceived some level of threat to their own health. 

When adjusted for covariates such as age, sex, annual income and other Internet activities related to the pandemic, Black people were significantly more likely to report using telehealth than white were people. 

In an unadjusted association of respondents' race and the odds of reporting telehealth use because of the pandemic, Black people, Latino people and those identifying as other races had significantly higher odds than white respondents.

"The perceived threat of the pandemic to respondents’ health modified the findings, with Black respondents reporting greater telehealth use than whites only among those who perceive a minor rather than no threat or a major health threat," wrote the researchers.

"Patients who deem the pandemic as a minor health threat may be the group where telehealth marginally makes the most sense because they face some need for healthcare. Conversely, those who perceive no health threat can avoid or postpone a visit, while those who perceive a major threat may require an in-person visit and believe it is worth the risk of potential COVID-19 exposure," they explained.

THE LARGER TREND

The JAMIA study presents an interesting contrast to prior studies of telehealth use among people of color. For example, a study of more than 52,000 Mt. Sinai patients who sought care between March and May found that Black patients were less likely than white ones to use telehealth. 

The study authors propose that one reason for this may be that the Pew Research data was for the whole country rather than one region; another might be that the data was for Internet users, who may be more comfortable using telehealth.

They also note the importance of expanding broadband access, a sentiment echoed by many telehealth advocates, including those in Congress.

"For populations who still face these barriers, sustained implementation of telehealth post-pandemic requires ensuring availability of Broadband access, access to telehealth via multiple modes, and increased assistance with using telehealth," wrote the researchers.

ON THE RECORD

"During widespread crises, like a pandemic or a natural disaster, telehealth can provide uninterrupted healthcare access, but technological changes risk contributing to disparities because systemic racism creates fractures between who is likely to benefit," wrote the researchers.

"A key takeaway of this study of telehealth use during the COVID-19 pandemic is that it is possible for racial minorities in the U.S. to not fall behind in adopting telehealth," they added.

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