Disparities in Access to Teledermatology During the COVID-19 Pandemic in Detroit, Michigan
Main Article Content
Keywords
COVID-19, Telemedicine, Teledermatology, Health Disparities, Access, Health Equity
Abstract
Background: Teledermatology became a necessary modality for dermatologic patient care during the COVID-19 pandemic. Due to disparities in access to technology, “The Digital Divide” refers to worsening health care disparities despite telemedicine’s best efforts to improve access.
Methods: Retrospective chart review was performed of all patients who were scheduled to be seen in dermatology during the first wave of pandemic (March 27, 2020 to April 27, 2020). Demographic characteristics of patients who pursued virtual visits was compared with those who did not.
Results: Compared to patients who canceled office visits, patients who completed virtual visit appointments were more likely to be younger (mean age 37.8 versus 45.5 years), female (68.7% versus 62.9%, p=0.01), unmarried (68.7% versus 61.0%, p<0.01). Of the diagnoses rendered during virtual visits, 53.3% were associated with dermatoses.
Conclusions: Patient populations above the age of 65 were less likely to complete a video visit, regardless of socioeconomic factors. Future policies must take marginalized populations into account to improve ease of access to technological services.
References
2. Duong TA, Cordoliani F, Julliard C, et al. Emergency department diagnosis and management of skin diseases with real-time teledermatologic expertise. JAMA Dermatol. 2014;150(7):743-747. doi:10.1001/jamadermatol.2013.7792
3. Chen Y, Pradhan S, Xue S. What are we doing in the dermatology outpatient department amidst the raging of the 2019 novel coronavirus? J Am Acad Dermatol. 2020;82(4):1034. doi:10.1016/j.jaad.2020.02.030
4. Perkins S, Cohen JM, Nelson CA, Bunick CG. Teledermatology in the Era of COVID-19: Experience of an Academic Department of Dermatology. J Am Acad Dermatol. Published online April 16, 2020. doi:10.1016/j.jaad.2020.04.048
5. Price KN, Thiede R, Shi VY, Curiel-Lewandrowski C. Strategic Dermatology Clinical Operations During COVID-19 Pandemic. J Am Acad Dermatol. Published online April 8, 2020. doi:10.1016/j.jaad.2020.03.089
6. Peltz-Rauchman CD, Divine G, McLaren D, et al. Response to survey directed to patient portal members differs by age, race, and healthcare utilization. JAMIA Open. 2019;2(4):429-433. doi:10.1093/jamiaopen/ooz061
7. Bush RA, Richardson AC, Cardona-Grau D, Din H, Kuelbs CL, Chiang GJ. Patient Portal Usage in Pediatric Urology: Is it Meaningful Use for Everyone? Urol Pr. 2018;5(4):279-285. doi:10.1016/j.urpr.2017.05.002
8. McGrail KM, Ahuja MA, Leaver CA. Virtual Visits and Patient-Centered Care: Results of a Patient Survey and Observational Study. J Med Internet Res. 2017;19(5):e177. doi:10.2196/jmir.7374
9. Uscher-Pines L, Malsberger R, Burgette L, Mulcahy A, Mehrotra A. Effect of Teledermatology on Access to Dermatology Care Among Medicaid Enrollees. JAMA Dermatol. 2016;152(8):905-912. doi:10.1001/jamadermatol.2016.0938
10. Lee I, Kovarik C, Tejasvi T, Pizarro M, Lipoff JB. Telehealth: Helping your patients and practice survive and thrive during the COVID-19 crisis with rapid quality implementation. J Am Acad Dermatol. 2020;82(5):1213-1214. doi:10.1016/j.jaad.2020.03.052
11. McGee JS, Reynolds RV, Olbricht SM. Fighting COVID-19: Early teledermatology lessons learned. J Am Acad Dermatol. 2020;83(4):1224-1225. doi:10.1016/j.jaad.2020.06.027
12. Social Deprivation Index (SDI). Accessed January 30, 2021. https://www.graham-center.org/rgc/maps-data-tools/sdi/social-deprivation-index.html
13. Bureau UC. American Community Survey (ACS). The United States Census Bureau. Accessed January 30, 2021. https://www.census.gov/programs-surveys/acs
14. Watts G. COVID-19 and the digital divide in the UK. Lancet Digit Health. 2020;2(8):e395-e396. doi:10.1016/S2589-7500(20)30169-2
15. Ramsetty A, Adams C. Impact of the digital divide in the age of COVID-19. J Am Med Inform Assoc JAMIA. 2020;27(7):1147-1148. doi:10.1093/jamia/ocaa078
16. Bakhtiar M, Elbuluk N, Lipoff JB. The digital divide: How COVID-19’s telemedicine expansion could exacerbate disparities. J Am Acad Dermatol. 2020;83(5):e345-e346. doi:10.1016/j.jaad.2020.07.043
17. Su MY, Smith GP, Das S. Trends in teledermatology utilization during clinic reopening following COVID-19 closures. J Am Acad Dermatol JAAD. Published online December 1, 2020. doi:10.1016/j.jaad.2020.12.019
18. Miller RC, Stewart CR, Lipner SR. Retrospective study of trends in dermatology telemedicine and in-person visits at an academic center during COVID-19. J Am Acad Dermatol. Published online November 19, 2020. doi:10.1016/j.jaad.2020.11.015
19. Franciosi EB, Tan AJ, Kassamali B, O’Connor DM, Rashighi M, LaChance AH. Understanding the impact of teledermatology on no-show rates and health care accessibility: A retrospective chart review. J Am Acad Dermatol. Published online September 11, 2020. doi:10.1016/j.jaad.2020.09.019
20. Eberly Lauren A., Khatana Sameed Ahmed M., Nathan Ashwin S., et al. Telemedicine Outpatient Cardiovascular Care During the COVID-19 Pandemic. Circulation. 2020;142(5):510-512. doi:10.1161/CIRCULATIONAHA.120.048185
21. Alon T, Doepke M, Olmstead-Rumsey J, Tertilt M. The Impact of COVID-19 on Gender Equality. National Bureau of Economic Research; 2020. doi:10.3386/w26947
22. Syed ST, Gerber BS, Sharp LK. Traveling Towards Disease: Transportation Barriers to Health Care Access. J Community Health. 2013;38(5):976-993. doi:10.1007/s10900-013-9681-1
23. Lie E, Psoter KJ, Püttgen KB. Lower Socioeconomic Status is Associated with Delayed Access to Care for Infantile Hemangioma, a Cohort Study. J Am Acad Dermatol. Published online October 1, 2018. doi:10.1016/j.jaad.2018.09.041
24. Chaudhry SB, Armbrecht ES, Shin Y, et al. Pediatric access to dermatologists: Medicaid versus private insurance. J Am Acad Dermatol. 2013;68(5):738-748. doi:10.1016/j.jaad.2012.10.034
25. Asai Y, Nguyen P, Hanna TP. Impact of the COVID-19 pandemic on skin cancer diagnosis: A population-based study. PLOS ONE. 2021;16(3):e0248492. doi:10.1371/journal.pone.0248492
26. Gordon NP, Hornbrook MC. Differences in Access to and Preferences for Using Patient Portals and Other eHealth Technologies Based on Race, Ethnicity, and Age: A Database and Survey Study of Seniors in a Large Health Plan. J Med Internet Res. 2016;18(3):e50. doi:10.2196/jmir.5105
27. Roberts ET, Mehrotra A. Assessment of Disparities in Digital Access Among Medicare Beneficiaries and Implications for Telemedicine. JAMA Intern Med. 2020;180(10):1386. doi:10.1001/jamainternmed.2020.2666
28. Blundell AR, Kroshinsky D, Hawryluk EB, Das S. Disparities in telemedicine access for Spanish-speaking patients during the COVID-19 crisis. Pediatr Dermatol. Published online December 27, 2020. doi:10.1111/pde.14489
29. MEDICARE TELEMEDICINE HEALTH CARE PROVIDER FACT SHEET | CMS. Accessed February 1, 2021. https://www.cms.gov/newsroom/fact-sheets/medicare-telemedicine-health-care-provider-fact-sheet