Labadorf James, Nichols Matthew, Williams Tayana, Cunanan Celina, D'Anza Brian
School of Medicine, Department of Otolaryngology - Head and Neck Surgery Case Western Reserve University Cleveland USA.
Department of Digital Health and Telehealth University Hospitals Shaker Heights Ohio USA.
Health Care Sci. 2025 Aug 17;4(4):259-268. doi: 10.1002/hcs2.70033. eCollection 2025 Aug.
Telehealth has emerged as a powerful tool for managing chronic diseases and mental health conditions, offering increased access to care and improved patient outcomes. However, inequities in digital connectivity and technological resources have created significant disparities in access to these potentially life-changing services, disproportionately impacting marginalized and minoritized communities across the globe.
Data on 473,716 telehealth encounters occurring between January 1, 2022, and June 30, 2023 were retrieved from the electronic health records (EHR) system used by University Hospitals. These encounters were classified into three groups: attended, canceled, and no-show. Relative risk was calculated based on age, sex, and race, and a multivariate linear regression was performed with age, sex, and race as inputs, to determine their effect on the encounter outcome.
Our analysis identified significant differences in relative risk between demographic groups. Patients 20-39 years of age had a high relative risk of cancellation and no-show, and Black patients demonstrated the highest relative risk for cancellation and no-show. The regression analysis illustrated a statistically significant link between no-shows and patients with a cellular plan with no other internet subscription ( < 0.001), smartphone ownership ( < 0.001), and not having a computer ( < 0.05).
This study highlights the clinical repercussions of the digital divide, as patients relying on a mobile phone and data plan to attend telehealth visits were more likely to no-show. Current disparities in digital connectivity for historically marginalized populations heightens the risk of creating a digital underclass. There is evidence this study may be applicable in multiple countries across the world. Further research on the causes of the observed no-shows is necessary to ensure equitable delivery of digital healthcare services.
远程医疗已成为管理慢性病和心理健康状况的有力工具，能增加医疗服务的可及性并改善患者治疗效果。然而，数字连接和技术资源的不平等导致在获取这些可能改变生活的服务方面存在显著差异，对全球边缘化和少数族裔社区产生了不成比例的影响。
从大学医院使用的电子健康记录（EHR）系统中检索了2022年1月1日至2023年6月30日期间发生的473,716次远程医疗会诊数据。这些会诊分为三组：参加、取消和未出现。根据年龄、性别和种族计算相对风险，并以年龄、性别和种族为输入进行多元线性回归，以确定它们对会诊结果的影响。
我们的分析发现不同人口群体之间的相对风险存在显著差异。20 - 39岁的患者取消和未出现的相对风险较高，黑人患者取消和未出现的相对风险最高。回归分析表明，未出现与会拥有仅手机套餐而无其他互联网订阅（<0.001）、拥有智能手机（<0.001）以及没有电脑（<0.05）的患者之间存在统计学上的显著关联。
本研究突出了数字鸿沟的临床影响，因为依赖手机和数据套餐参加远程医疗会诊的患者更有可能未出现。历史上被边缘化人群目前在数字连接方面的差异增加了形成数字底层阶级的风险。有证据表明本研究可能适用于世界上多个国家。有必要对观察到的未出现情况的原因进行进一步研究，以确保数字医疗服务的公平提供。
