Veterans Health Stakeholders Identify Priorities to Ensure Health Equity in Telehealth

The COVID-19 pandemic sparked a rapid uptake of telehealth technologies, as health care providers sought ways to assist patients without the need for in-person visits. Yet, wider adoption of the technology also has raised the potential for new and different types of health care inequities.

In a new report in Journal of General Internal Medicine, personnel from the Veterans Health Administration (VHA) published a list of priorities for researchers as they begin to examine real and potential inequities in telehealth.

The study authors noted that the pandemic exposed significant disparities within the United States’ health care system, as certain communities have been disproportionately affected. One of the ways health care providers sought to reach out to patients during this time was through telehealth, but the investigators said that shift opened up new potential for disparities. For instance, they said certain populations were more reliant upon audio-only telehealth rather than video-based services.

“Virtual care will likely remain a significant part of ambulatory care in the postpandemic era, so it is critical to ensure designs and implementations of virtual care will not worsen current inequities in access and health outcomes,” the investigators said.

They decided to convene a think tank of clinicians, researchers, and operational partners from the VHA to identify future research needs and priorities in the hopes of eliminating telehealth-related inequities and fostering “TechQuity.” The 43-member strong team was from different locations, backgrounds, and VHA offices. They eventually chose 4 priorities they said were paramount in addressing telehealth inequities.

The first was figuring out how best to measure inequities in virtual care. In that regard, they said next steps should include regularly collecting data related to social determinants of health and creating virtual care health equity metrics, among other steps.

Second, the team said investigators should prioritize identifying ways to address emerging virtual-care inequities. This task will require performing a comprehensive assessment of existing telehealth resources and barriers to patient utilization of those resources. It will also require an examination of different populations’ trust levels and preferences to ensure telehealth resources are deployed in ways that meet different populations’ needs, the authors wrote.

Thirdly, the investigators said it is important to identify accommodations to ensure people with vision, hearing, cognitive, and physical impairments have equal access to virtual care. To achieve this goal, they said investigators should work closely with key advocacy groups such as Paralyzed Veterans of America and the Disabled American Veterans.

Finally, the authors said a fourth priority is to examine potential adverse consequences of expanded virtual care. They said potential problems include delayed diagnoses or reductions in preventive care, provider burnout, and system-level inequities.

“Use of virtual care as a replacement represents a fundamentally different application of the technology; therefore, there is uncertainty regarding the potential for benefit and harm,” they wrote.

They concluded that health equity must be at the heart of the future deployment of telehealth services. Turning that hope into a reality, however, will require a deep understanding of the impact virtual care can have, as well as coordination between a wide variety of stakeholders, they said.

“Although much work remains to be done, the priorities identified in our think tank represent important steps toward achieving TechQuity in virtual care at the VHA,” they emphasized.

Reference

Walsh C, Sullivan C, Bosworth HB, et al. Incorporating techquity in virtual care within the Veterans Health Administration: identifying future research and operations priorities. J Gen Intern Med. 2023;1-9. doi:10.1007/s11606-023-08029-2