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Last spring, lockdowns and concerns about the highly contagious coronavirus resulted in the U.S. Centers for Disease Control and Prevention (CDC) asking non-emergency medical care providers to prioritize telehealth consultations. Suddenly people living in cities with a doctor on every corner were just as eager to get their health care via phone, computer, or digital app as those who lived hundreds of miles from the nearest hospital. And although telehealth utilization climbed across the board, a new study suggests that it has increased the most among higher-income people who live in metropolitan areas.

The study, which was published in the American Journal of Preventive Medicine, pulled data from more than 6 million participants in employer-sponsored health insurance plans between January 2019 and July 2020. The researchers analyzed claims to learn about how telehealth was being utilized before and after March 13, 2020, which is when the U.S. declared a national emergency because of the coronavirus.

According to the findings, telehealth increased 20-fold in the months following the March 13 milestone. Although there was a notable uptick in telehealth use nationwide, the study authors found that:

  • Telehealth usage was slightly higher in metropolitan counties than it was in rural areas.
  • People living in low-income communities had a lower uptick in telehealth visits.
  • Telehealth use for children was lagging behind that for adults.

Though the findings are beneficial in further understanding (and improving) telehealth use, the study was limited in that it only included people using employer-based insurance. This excludes low-income individuals on Medicaid and older individuals on Medicare, both of whom face barriers to telehealth care, according to previous studies.

What Are the Barriers to Telehealth Access?

Despite the rise in telehealth over the last year, there are still many people who cannot or choose not to utilize it.

According to a February 2020 paper published in the Journal for Nurse Practitioners, the technology element provides a challenge for a number of groups, including older adults who don’t have as much experience with the equipment; low-income patients who may not have access to smartphones, tablets, and computers; and patients who live in areas with poor internet bandwidth speeds.

Similarly, there are families who don’t have access to internet at home. According to a 2019 survey from the Pew Research Center, only 66 percent of Black adults and 61 percent of Hispanic adults said they had access to broadband at home; 77 percent of white adults said they had access. Additionally, 24 percent of Hispanic adults and 23 percent of Black adults said they were “smartphone-only” internet users; this is compared to 12 percent of white adults.

But it isn’t just about having the tools and technology: It’s also about having health care to begin with. An August 2020 study published in the Journal of the American Medical Informatics Association examined whether racial and ethnic differences in telehealth use existed during the peak pandemic period among New York City patients seeking care for COVID-19-related symptoms. The researchers found that Black and Hispanic people were more likely to visit the ER or doctor’s office during the pandemic than were white and Asian people. The researchers cited a number of factors may have contributed to these findings, such as patients not having access to a usual source of care (such as a primary care physician) or being sicker.

Considering that telehealth could lead to more cost-effective health care, more research needs to be done about the barriers to telehealth access in order for more people to benefit from it.

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Cantor J, et al. Who Is (and Isn’t) Receiving Telemedicine Care During the COVID-19 Pandemic. American Journal of Preventative Medicine. March 6, 2021. https://doi.org/10.1016/j.amepre.2021.01.030

Gajarawala S, et al. Telehealth Benefits and Barriers. Journal for Nurse Practitioners. February 2021. doi: https://doi.org/10.1016/j.nurpra.2020.09.013

Healthcare Facilities: Managing Operations During the COVID-19 Pandemic. Centers for Disease Control and Prevention. March 17, 2021. https://www.cdc.gov/coronavirus/2019-ncov/hcp/guidance-hcf.html

Perin A, et al. Smartphones help blacks, Hispanics bridge some – but not all – digital gaps with whites. Pew Research Center. August 20, 2019. https://www.pewresearch.org/fact-tank/2019/08/20/smartphones-help-blacks-hispanics-bridge-some-but-not-all-digital-gaps-with-whites/

Weber E, et al. Characteristics of telehealth users in NYC for COVID-related care during the coronavirus pandemic. Journal of the American Medical Informatics Association. August 31, 2021. https://doi.org/10.1093/jamia/ocaa216