Telehealth Is Helping More People Get Surgical Care

During the height of the pandemic, non-essential surgeries were postponed for a later date and telehealth worked to fill the need for in-person care. Now, new research shows that telemedicine helped increase access to surgical care, but some disparities remained.

From March 2020 to June 2020, all non-essential elective surgical procedures and consultations were limited in Massachusetts, shifting some in-person appointments virtually. To better understand how historically underrepresented surgical patients used telehealth during the COVID-19 pandemic, researchers from the Brigham and Women’s Hospital dove into the data. 

Using the electronic health records of new patients seeking consultations within the hospital’s Division of General and Gastrointestinal Surgery, the researchers found that telemedicine increased access to surgical care among traditionally underrepresented surgical patients.

Increased Access to Care

The study was split into two phases. During phase one (March 24 to June 23, 2020), patients were observed when stay-at-home recommendations went into place and elective surgeries were suspended.

During this time period, Brigham increased access to telemedicine for study participants by enrolling them in a patient portal system, distributing internet devices, and integrating a video platform into the electronic health records. 347 in-person and 638 virtual visits were completed during this part of the study.

In phase two (June 24 to December 31, 2020), patients were observed when Massachusetts issued reopening guidelines, and 2,922 in-person and 1,001 virtual visits were completed.

“Black patients in phase two used more virtual care than our White patients,” Gezzer Ortega, MD, MPH, instructor of surgery at the Brigham and Women’s Hospital and Harvard Medical School and one of the study’s authors, told Verywell.

Ortega theorizes telemedicine increased access for historically underrepresented patients due to a mix of personal or cultural preferences, concerns about potential COVID-19 exposure during an in-person clinic visit, and privacy concerns.

But Ortega and his team also observed differences in whether patients used video versus audio-only visits. For example, “patients with older age, lower educational level (high school or less), and non-English primary language patients used video less than audio,” Ortega said.

The study found that Hispanic and Latinx patients had more audio-only consultations than other racial and ethnic groups during phase one. Latinx patients accounted for 19.1% of audio-only visits compared to 11.1% among Black patients. White patients accounted for the majority of audio-only and video visits.

These findings suggest that improvements can be made to increase digital access and literacy, such as increasing knowledge on using the mouse or keyboard, operating the internet, and accessing emails or secure links.

Why Telemedicine Access Is Important

Since a vast majority of pre- and post-surgical care can be conducted online, telemedicine can be a safe and convenient option for patients, according to Karl Minges, PhD, MPH, interim dean at the University of New Haven’s School of Health Sciences.

“This is especially true in rural or underserved areas where transportation issues exist and it can take hours to travel for a 15-minute appointment,” Minges told Verywell. Coupled with avoiding unnecessary trips to the hospital, telemedicine can save time and reduce the number of workdays missed.

However, in order for telemedicine to be effective, “it requires access to technology, broadband internet, digital literacy, health literacy, and other resources which can serve as an additional barrier to accessing surgical care in which these groups, through many prior studies have been demonstrated to have disparities in access to and outcomes of surgical care,” Minges said. 

Moving Forward 

Ortega said that the goal of the study was to inform health systems and policies on best practices for providing equitable access to surgical care.

“This study provides insight into how policies impacted surgical care and how they can exacerbate or mitigate disparities that already exist,” he explained. “Analyzing the impact of our public health policies, local interventions, and efforts to reduce disparities will guide us in making better decisions for the communities we aim to serve.”

Ortega and his team hope to continue this line of work by reducing language barriers in telemedicine, providing additional resources to help patients navigate these platforms, and improving providers’ level of comfort with digital platforms.

“It is virtually impossible for health policy decisions to impact all patients the same way, no matter how well-intended they are,” Ortega said. “We must challenge ourselves to evaluate the impact on health equity and make decisions that prioritize not only safety and public health, but also equity and access for all patients, even during a crisis.”

The information in this article is current as of the date listed, which means newer information may be available when you read this. For the most recent updates on COVID-19, visit our coronavirus news page.