Seven million Californians live in a region with a shortage of physicians. Although telehealth can be used to address that gap, write experts from the University of California, Los Angeles in a new report, policymakers must consider the ways in which vulnerable people are left behind by technological advances.
The report, jointly issued by the UCLA Latino Policy and Politics Initiative and the UCLA Health Center for the Study of Latino Health and Culture, notes that relying on telehealth during the coronavirus pandemic and beyond may not be feasible for people who don’t have access to broadband Internet – or for clinics that may not have the resources to set up telehealth infrastructure
“Especially hard hit have been safety-net clinics serving medically underserved and rural areas, many facing alarming drops in Medicaid and Medicare reimbursements as a result of the drop in face-to-face consultations,” wrote the report authors.
“Not only have patients been affected by their lack of internet or devices to support virtual visits, but also by their providers’ lack of broadband connectivity, equipment, and electronic medical record and electronic health record system capacity limitations,” they continued.
WHY IT MATTERS
The COVID-19 crisis has exacerbated an already dire gap in access to healthcare, with patients often unable to seek in-person services. At the same time, many in vulnerable populations are unable to isolate at home. “When compared with non-Latino Whites, Latinos are less likely to have a regular source of health care and have fewer physician visits,” report authors noted.
“Yet these same already vulnerable patients are the ones that have been unable to ‘wall themselves off’ from infection because of their jobs in agriculture, sanitation, and front-line retail … and they are already dying in disproportionate numbers,” they wrote. The UCLA report authors pointed out that the so-called routine or elective care being postponed during the pandemic is often vital for treating chronic healthcare conditions.
“Those in the safety-net already experience delays in access to specialty care, and now with few face-to-face visits and absent infrastructure to support telehealth, vulnerable populations have little access to specialty care,” they wrote. “Health care delays and postponement of chronic care management can rapidly impact patient outcomes and health in the long-term,” they continued.
Telehealth can act as a way for providers to augment access to care, even after the need for self-isolation has passed. However, the report authors suggested a number of actions for policymakers to ensure the needs of vulnerable people will be centered in telehealth advancements. “When designing and implementing health technology, culture, needs, and population demographics must be taken into account,” they wrote.
“In California, nearly 44% of the population speaks a language other than English at home, and Spanish-speaking physicians are the most under-represented in the physician workforce,” report authors continued. “Medical interpreter use will need to be systematically incorporated into telehealth technology to ensure language-concordance is addressed.”
The UCLA team’s recommendations also included the expansion of telehealth in specialty and acute-care settings, the pursuit of partnerships with smart-device providers to connect patients with remote-monitoring resources, and the continuation of policies that minimize out-of-pocket costs for patient services.
THE LARGER TREND
Even before the pandemic swept the country, safety net providers were facing obstacles to implementing telehealth adoption. Several of the concerns outlined in a report released last year, such as infrastructure issues and patient-specific challenges, remain despite pro-telehealth regulatory and licensing changes in recent months.
Since the start of the COVID-19 crisis, the Federal Communications Commission has issued millions of dollars in grants to shore up health systems’ telemedicine programs and infrastructure. Many of these grants, according to the agency, will be directed toward furthering access among vulnerable communities.
ON THE RECORD
“Telehealth offers a rapid response way of achieving continued primary care, while concurrently minimizing non-urgent patient flow into emergency departments, hospitals, and clinics; a necessary precaution to safeguard the safety and well-being of our essential medical workers,” wrote the UCLA report authors.
“By building a foundation for widespread and inclusive telehealth implementation, policymakers can ensure our healthcare workforce is able to meet the needs of all patients, especially those residing in linguistically and medically underserved communities.”
