The Kaiser Family Foundation notes that awareness of health disparities ramped up at the beginning of this century when the U.S. Surgeon General reported uneven access to mental healthcare and the imbalance of tobacco use among various races and ethnicities. Unfortunately, identifying the many inequities hasn’t done much to improve the situation — and for some groups, it's worse than ever.
But with the necessary expansion of telehealth during the COVID-19 pandemic, people who have chronically experienced healthcare inequality now have a tool to help them move towards better access to care. It certainly won’t be an overnight cure to the ailments of our healthcare system. However, virtual healthcare can impact the patients who have been excluded through no fault of their own when administered correctly.
The statistics speak volumes
The 2020 census revealed an increase in racial and ethnic diversity in the U.S. However, the balance of races and ethnicities remains strongly skewed to a white majority:
- White, non-Hispanic people make up 57.8% of our population.
- The second-largest group is Hispanic/Latino people, at 18.7%.
- Black/African American people make up 12.1% of our population, the third-largest group.
A 2022 study comparing health access, coverage, and use; health status, behaviors, and outcomes; and social determinants of health of people from five other racial/ethnic groups to White people assigned numbers to the reality of healthcare disparity:
- Black/African American people fared worse than White people in 45 of 61 measures.
- Hispanic people fared worse than White people in 39 of 61 measures.
- American Indian and Alaska Native (AIAN) people fared worse than White people in 34 of 61 measures.
These inequities immediately put people of color at increased risk when COVID-19 reached the U.S. and continues to work against them via increased risk of infection, hospitalization, and death.
Race and ethnicity aren’t the only factors that lead to healthcare inequality. What about those who live in rural areas and cannot easily access healthcare facilities? And members of LGBTQ+ communities, who face bias among their peers and providers? No matter the person’s color, if they can’t afford to get child care, take transportation to a doctor’s appointment, or take time off work for a medical test, they cannot attain their full health potential.
Telehealth has made some inroads
The U.S. Department of Health and Human Services says the use of telehealth for Medicare visits went from 840,000 in 2019 to 52.7 million in 2020 — a 63-fold increase! When the pandemic hit and people understood how the virus spread, telehealth quickly became a valuable tool to keep patients and providers safe during evaluation, diagnosis, and treatment.
Telehealth has reached people who never previously tried to access medical information or care. It has allowed them to ask questions and get advice in the privacy of their own homes or at work, rather than spending hours traveling to and from their provider — not to mention that always indeterminate time in the waiting room. They may be making their first contact with the healthcare system, live hours from their doctor, PA, or NP, or are tasked with caring for an elderly parent … but they’re still able to keep a healthcare appointment.
For the most part, providers like virtual healthcare, too. Missed appointments have decreased, and practitioners can focus on the individual on the screen with fewer distractions and interruptions. And as they work to make healthcare more accessible to all, they can share their expertise and experience with patients they may never have seen if not for the option of telehealth.
The right telehealth preparation and training can accelerate change
Healthcare providers jumped into telehealth out of necessity two years ago, many without formal training. Along with overburdened work schedules, they’ve had to learn the basics and the nuances of telehealth as they go. To maintain telehealth as a valuable opportunity for all patients, we must help practitioners improve their own virtual healthcare skills — and the experience for their patients. When you’re not together in the same room, it’s more important than ever to make the right connections. How can your providers do that?
- Work to put patients at ease with both words and body language that make them feel comfortable and grateful that they chose a virtual visit.
- Speak each patient’s language, both literally and figuratively. That may mean using a translator, brushing up on health issues faced by transgender patients, or knowing and recommending community resources.
- Be aware of what’s happening in the background. Is the patient safe? Alone? Is someone interfering with their desire to access care?
- Determine if mental health factors contribute to a physical ailment, like depression or anxiety due to a lack of health insurance, prolonged unemployment, child or eldercare responsibilities, or homelessness.
- Ask the right questions, listen carefully to the answers, then determine the best medical response.
Give your providers easy access to training resources that include this information as well as how to conduct quality remote examinations, plus updates on telehealth regulations and reimbursement.
Far from perfect, but a step in the right direction
Unfortunately, telehealth still doesn’t work for everyone. A lack of internet and device access is a barrier for some prospective patients. In addition, cultural mistrust of medical care, in general, remains an issue. And providers know that patients must be seen in person in some cases. However, virtual healthcare is here to stay and offers the potential to reach individuals and communities where healthcare access has been minimal or nonexistent. Let’s help maximize that potential by training MD, PA, NP, RN, and MA students on telehealth best practices right from the start and help become part of the solution to providing quality healthcare for all.
