Ternes Sara, Lavin Lauren, Vakkalanka J Priyanka, Healy Heather S, Merchant Kimberly As, Ward Marcia M, Mohr Nicholas M
Department of Emergency Medicine, University of Iowa Carver College of Medicine, Iowa City, IA, USA.
Department of Epidemiology, University of Iowa College of Public Health, Iowa City, IA, USA.
J Telemed Telecare. 2024 Apr 22:1357633X241245459. doi: 10.1177/1357633X241245459.
The COVID-19 public health emergency led to an unprecedented rapid increase in telehealth use, but the role of telehealth in reducing disparities in access to care has been questioned. The objective of this study was to conduct a systematic review to summarize the available evidence on how telehealth during the COVID-19 pandemic was associated with telehealth utilization for minority groups and its role in health disparities.
We conducted a systematic review focused on health equity and access to care by searching for interventional and observational studies using the following four search domains: telehealth, COVID-19, health equity, and access to care. We searched PubMed, Embase, Cochrane CENTRAL, CINAHL, telehealth.hhs.gov, and the Rural Health Research Gateway, and included any study that reported quantitative results with a control group.
Our initial search yielded 1970 studies, and we included 48 in our final review. The most common dimensions of health equity studied were race/ethnicity, rurality, insurance status, language, and socioeconomic status, and the telehealth applications studied were diverse. Included studies had a moderate risk of bias. In aggregate, most studies reported increased telehealth use during the pandemic, with the greatest increase in non-minority populations, including White, younger, English-speaking people from urban areas.
We found that despite rapid adoption and increased telehealth use during the public health emergency, telehealth did not reduce existing disparities in access to care. We recommend that future work measuring the impact of telehealth focus on equity so that features of telehealth innovation can reduce disparities in health outcomes.
新冠疫情公共卫生紧急事件导致远程医疗的使用前所未有的迅速增加，但远程医疗在减少医疗服务可及性差异方面的作用受到了质疑。本研究的目的是进行一项系统综述，以总结关于新冠疫情期间远程医疗如何与少数群体的远程医疗利用相关联及其在健康差异中作用的现有证据。
我们通过在以下四个搜索领域搜索干预性和观察性研究，进行了一项聚焦于健康公平和医疗服务可及性的系统综述：远程医疗、新冠疫情、健康公平和医疗服务可及性。我们检索了PubMed、Embase、Cochrane CENTRAL、CINAHL、telehealth.hhs.gov和农村卫生研究网关，并纳入了任何报告有对照组定量结果的研究。
我们最初的搜索产生了1970项研究，最终综述纳入了48项。所研究的健康公平最常见维度是种族/族裔、农村地区、保险状况、语言和社会经济地位，所研究的远程医疗应用多种多样。纳入的研究存在中度偏倚风险。总体而言，大多数研究报告称疫情期间远程医疗的使用有所增加，非少数群体，包括白人、年轻人、来自城市地区的说英语的人增加最多。
我们发现，尽管在公共卫生紧急事件期间远程医疗迅速被采用且使用增加，但远程医疗并未减少现有的医疗服务可及性差异。我们建议未来衡量远程医疗影响的工作应关注公平性，以便远程医疗创新的特点能够减少健康结果方面的差异。
