Telehealth use factors.

Health Literacy, Location Impact Type of Telehealth Modality Used

By Mark Melchionna

–¬†While reviewing patient demographics and social determinants of health, a JAMA Network Study found that low health literacy and high area deprivation index (ADI) can determine how telehealth is used and the modality selected.

Amid the rapid uptake of telehealth during the COVID-19 pandemic, providers have gained a better understanding of how to deliver care virtually. But the impact social determinants of health have on patient actions requires further research.

For the study, researchers included information on 18,130 telehealth visits. Demographics regarding the patients who participated in the included visits varied. The age range was 18 to 101; 48 percent had noncommercial health insurance; 58 percent were women; 2 percent were Asian; 15 percent were Black; 1 percent were Hispanic; and 82 percent were White.

Researchers also noted that 675 of the appointments included in the study were no-shows.

Those who participated in audio-only visits displayed a lower brief health literacy screen (BHLS) score and often had higher ADI, which indicates low socioeconomic status. Researchers found that lower BHLS scores relate to difficulties in understanding how to use digital health technology.

Regarding no-shows, low health literacy was not associated with overall telehealth no-shows, while higher ADI was linked to a higher no-show likelihood.

The main takeaway of this study was that although telehealth can provide many benefits, there are also many accessibility factors associated with its use. Providers must consider that some patients may experience difficulties obtaining and using telehealth technology due to their level of health literacy and ADI.

The study’s limitations mainly relate to the fact that the data came from one clinical location and that the median level of health literacy fell in the upper quadrant, indicating relatively high levels of health literacy and affecting generalizability.

Previous research has also shown that some patients may need support to access video-based telehealth visits.

In April, Kaiser Permanente published a study showing that medical assistants working with patients to connect to video visits could help narrow the digital divide. The study assessed an initiative called ‘virtual rooming,’ which involved a medical assistant calling the patient 15 minutes before the telehealth appointment to help connect them to the video visit.

But, amid virtual care access difficulties, the government has tried to break down barriers.

A study published in May described how a federal telehealth waiver led to improved access to virtual healthcare for Medicare beneficiaries, even in disadvantaged neighborhoods. Before the implementation of the waiver, the proportion of Medicare beneficiaries who participated in a telehealth visit failed to meet 1 percent. However, researchers found that a Centers for Medicare and Medicaid Services telehealth waiver boosted telehealth use among beneficiaries living in the least disadvantaged neighborhoods 56-fold. At the same time, individuals in the most deprived communities experienced a 28.9-fold increase.

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