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Tierney AA, Mosqueda M, Cesena G, Frehn JL, Payán DD, Rodriguez HP. Telemedicine Implementation for Safety Net Populations: A Systematic Review. Telemed J E Health 2024; 30:622-641. [PMID: 37707997 PMCID: PMC10924064 DOI: 10.1089/tmj.2023.0260] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/19/2023] [Revised: 07/26/2023] [Accepted: 07/27/2023] [Indexed: 09/16/2023] Open
Abstract
Background: Telemedicine systems were rapidly implemented in response to COVID-19. However, little is known about their effectiveness, acceptability, and sustainability for safety net populations. This study systematically reviewed primary care telemedicine implementation and effectiveness in safety net settings. Methods: We searched PubMed for peer-reviewed articles on telemedicine implementation from 2013 to 2021. The search was done between June and December 2021. Included articles focused on health care organizations that primarily serve low-income and/or rural populations in the United States. We screened 244 articles from an initial search of 343 articles and extracted and analyzed data from N = 45 articles. Results: Nine (20%) of 45 articles were randomized controlled trials. N = 22 reported findings for at least one marginalized group (i.e., racial/ethnic minority, 65 years+, limited English proficiency). Only n = 19 (42%) included African American/Black patients in demographics descriptions, n = 14 (31%) LatinX/Hispanic patients, n = 4 (9%) Asian patients, n = 4 (9%) patients aged 65+ years, and n = 4 (9%) patients with limited English proficiency. Results show telemedicine can provide high-quality primary care that is more accessible and affordable. Fifteen studies assessed barriers and facilitators to telemedicine implementation. Common barriers were billing/administrative workflow disruption (n = 9, 20%), broadband access/quality (n = 5, 11%), and patient preference for in-person care (n = 4, 9%). Facilitators included efficiency gains (n = 6, 13%), patient acceptance (n = 3, 7%), and enhanced access (n = 3, 7%). Conclusions: Telemedicine is an acceptable care modality to deliver primary care in safety net settings. Future studies should compare telemedicine and in-person care quality and test strategies to improve telemedicine implementation in safety net settings.
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Affiliation(s)
- Aaron A. Tierney
- Department of Health Policy and Management, School of Public Health, University of California, Berkeley, Berkeley, California, USA
| | - Mariana Mosqueda
- Department of Health Policy and Management, School of Public Health, University of California, Berkeley, Berkeley, California, USA
| | - Gabriel Cesena
- Department of Health Policy and Management, School of Public Health, University of California, Berkeley, Berkeley, California, USA
| | - Jennifer L. Frehn
- Department of Health Policy and Management, Fielding School of Public Health, University of California, Los Angeles, Los Angeles, California, USA
| | - Denise D. Payán
- Department of Health, Society, and Behavior, University of California, Irvine, Irvine, California, USA
| | - Hector P. Rodriguez
- Department of Health Policy and Management, School of Public Health, University of California, Berkeley, Berkeley, California, USA
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Casillas A, Abhat A. The Los Angeles County Department of Health Services Health Technology Navigators: A novel health workforce to digitally empower patient communities in safety net systems. THE JOURNAL OF MEDICINE ACCESS 2024; 8:27550834231223024. [PMID: 38225933 PMCID: PMC10788075 DOI: 10.1177/27550834231223024] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 03/21/2023] [Accepted: 12/08/2023] [Indexed: 01/17/2024]
Abstract
Significant disparities in the uptake of digital health tools have been previously described. Studies have found that low perceived confidence to engage with digital health resources among medically underserved patients partially account for this. To address barriers to digital health engagement (specifically around patient portal enrollment and use), the Los Angeles County Department of Health Services (LAC DHS) introduced the Health Technology Navigators program. To our knowledge, this is the first formal digital health workforce implemented in a safety net system. The objectives of the editorial are to describe the evolution and roles of the health technology navigators and their early effects within LAC DHS, the second largest safety net health system in the United States.
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Affiliation(s)
| | - Anshu Abhat
- Los Angeles County Department of Health Services, Los Angeles, CA, USA
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Jaworski BK, Webb Hooper M, Aklin WM, Jean-Francois B, Elwood WN, Belis D, Riley WT, Hunter CM. Advancing digital health Equity: Directions for behavioral and social science research. Transl Behav Med 2022; 13:132-139. [PMID: 36318232 DOI: 10.1093/tbm/ibac088] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/07/2022] Open
Abstract
Abstract
The field of digital health is evolving rapidly and encompasses a wide range of complex and changing technologies used to support individual and population health. The COVID-19 pandemic has augmented digital health expansion and significantly changed how digital health technologies are used. To ensure that these technologies do not create or exacerbate existing health disparities, a multi-pronged and comprehensive research approach is needed. In this commentary, we outline five recommendations for behavioral and social science researchers that are critical to promoting digital health equity. These recommendations include: (i) centering equity in research teams and theoretical approaches, (ii) focusing on issues of digital health literacy and engagement, (iii) using methods that elevate perspectives and needs of underserved populations, (iv) ensuring ethical approaches for collecting and using digital health data, and (v) developing strategies for integrating digital health tools within and across systems and settings. Taken together, these recommendations can help advance the science of digital health equity and justice.
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Affiliation(s)
- Beth K Jaworski
- Office of Behavioral and Social Sciences Research, National Institutes of Health , Bethesda, MD , USA
| | - Monica Webb Hooper
- National Institute on Minority Health and Health Disparities, National Institutes of Health , Bethesda, MD , USA
| | - Will M Aklin
- National Institute on Drug Abuse, National Institutes of Health , Bethesda, MD , USA
| | - Beda Jean-Francois
- National Center for Complementary and Integrative Health, National Institutes of Health , Bethesda, MD , USA
| | - William N Elwood
- Office of Behavioral and Social Sciences Research, National Institutes of Health , Bethesda, MD , USA
| | - Deshirée Belis
- Office of Behavioral and Social Sciences Research, National Institutes of Health , Bethesda, MD , USA
| | - William T Riley
- Office of Behavioral and Social Sciences Research, National Institutes of Health , Bethesda, MD , USA
| | - Christine M Hunter
- Office of Behavioral and Social Sciences Research, National Institutes of Health , Bethesda, MD , USA
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