It’s critical to think of a patient’s well-being beyond the walls of a doctor’s office; this includes social determinants of health such as digital connectivity. —Brian D’Anza, MD
Explore This IssueAugust 2021
“The rate of technological changes is becoming more rapid, leaving many people behind, and will continue to do so,” Dr. Grayson said. “This affects not only patients with socioeconomic status disadvantages, but also the aging population—many of whom are not tech savvy. The pandemic brought these issues to the forefront, as technology was really tested, and [we] found that many families lacked technological infrastructure.”
COVID-19 vaccination distribution methods exemplified how patients lacking technology could be left behind. Web-based vaccine registration patient portal systems such as MyChart require digital literacy and access. “Some communities struggled to reach vulnerable populations with vaccines due to reliance on digital platforms,” Dr. Sykes said. “Many senior adults needed help navigating registration portals and health systems, and public health agencies weren’t prepared with human or financial resources to provide technical assistance.
“The more expensive a technology is and the more infrastructural demands it requires to support its widespread use, the more likely it is to produce social disparity gaps,” Dr. Sykes continued. “The biggest issue that remains is the incorrect assumption that everyone carries a smartphone and has consistent Internet access. When access is assumed, it’s highly likely that someone will be left behind.”
The Effects on Otolaryngology Care
Technology aside, the effects of racial inequality, poverty, and unequal healthcare access in the United States are well known to otolaryngologists and other surgeons (Health Aff (Millwood). 2013;32:1046-1053). They see higher rates of smoking, head and neck cancer, and delayed disease presentation in patients from vulnerable groups (JAMA Otolaryngol Head Neck Surg. 2019;145:249-250; Head Neck. 2016;38 Suppl 1:E1826-E1832).
Patients who need care the most are often those with the least access to resources, said Dr. Grayson. In her practice, many head and neck cancer patients come from all over the state of Alabama, often with limited resources to return for additional medical care. “It’s vital that we stay updated on their medical status, how to troubleshoot issues at home with the resources available to them, and when early intervention with us is necessary,” she said. “While other patients have improved access with technologies, disadvantaged patients are getting left behind with no end to that separation of access in sight.”
Recent research findings showing worsening inequity in the use of telehealth during COVID-19 wasn’t surprising to Dr. D’Anza, who is also an otolaryngologist and sinus specialist in the department of otolaryngology at University Hospitals in Cleveland and an assistant professor at Case Western Reserve University School of Medicine. University Hospitals analyzed preliminary data looking at which patient populations in Cleveland participated in audiovisual calls versus audio-only sessions or phone calls. They found that among approximately 400,000 telehealth visits in 2020, African American patients used audiovisual visits nearly 40% less than the general population, which was mostly White.
These data line up with a study done by researchers at Mount Sinai Health System in New York City. Mount Sinai researchers analyzed more than 39,000 telehealth visits for COVID-19 and found that Black and Hispanic patients were two to three times more likely to present to the emergency room for an initial COVID-19 visit than were White patients (J Am Med Inform Assoc. 2020;27:1949-1954). Conversely, White patients were nearly twice as likely to present via telehealth for an initial COVID-19 visit rather than go the emergency room. Patients older than age 65 and non-English-speaking patients followed the same trends as Black patients.
In addition, according to data from the U.S. Health Information National Trends Survey, between 2014 and 2020, racial and ethnic minorities, older patients, and those with lower socioeconomic status were much less likely to access and use patient portals (National Cancer Institute. April 2021.).