The COVID-19 pandemic transformed the way that patients access health care. While previous studies have revealed inequities in telemedicine usage during the spring of 2020, there are fewer analyses of other aspects of its use during the pandemic, especially among surgical patients. Researchers at Brigham and Women’s Hospital analyzed the electronic health records of new patients seeking consultations within the hospital’s Division of General and Gastrointestinal Surgery from March through December 2020. Their findings, published in the Journal of the American College of Surgeons, reveal increased use of telemedicine among some historically underrepresented patient groups and may inform future efforts to improve telemedicine access.
“We can use digital health to reach populations that have historically not had optimal access to our health care system,” said corresponding author Gezzer Ortega, MD, MPH, of the Brigham’s Center for Surgery and Public Health. The United States has seen a significant increase in smart-phone use over the past decade. We are doing our best to meet patients where they are, and digital tools may help us bridge that gap, if we use them responsibly. “
The study included two phases, one of which spanned the Massachuetts Public Health Emergency (March 24 to June 23, 2020), when the state issued a stay-at-home advisory and elective surgeries were suspended. During this period, the Brigham developed initiatives to increase telemedicine access. These initiatives included enrolling patients in the patient portal system from under-resourced areas, disseminating internet enabled devices and integrating a video conference platform into the electronic medical record. During Phase 2 of the study (June 24 to December 31, 2020), Massachusetts issued reopening guidelines authorizing the resumption of non-essential elective surgeries.
Notably, in Phase 2 of the study, Black patients utilized telemedicine more than white patients even as in-person consultations increased. Hispanic/Latinx patients had audio-only consultations more than other ethnic groups during Phase I of the study, but not Phase 2, which could reflect improvements in digital access or literacy. However, there were still disparities in video-use, with patients older than their peers, those with lower education, and those with primary languages other than English being less likely to use virtual visits during Phase 2. The study found that women were more likely than men to use telemedicine.
The study authors point out that only one surgical division used telemedicine. During the COVID-19 pandemic, many populations have been unwilling or unable to seek medical care, and are therefore left out of research studies. The demographics of the hospital’s patients, which are similar in Massachusetts, limit the generalizability and require additional studies within populations with a greater proportion of racial or ethnic minorities, uninsured and non-English speaking populations.
Going forward, the researchers hope to continue to promote telemedicine access by reducing language barriers embedded in digital health platforms, providing better resources to help patients navigate these platforms, and improving physicians’ comfort with digital systems, especi