Subscribe to RSS
DOI: 10.1055/a-2016-7417
A Prescription for Internet: Feasibility of a Tablet Loaner Program to Address Digital Health Inequities
Funding This initiative was supported by a 2020 Federal Communications Commission COVID-19 Telehealth Grant.![](https://www.thieme-connect.de/media/10.1055-s-00035026/202302/lookinside/thumbnails/10-1055-a-2016-7417_202210cr0278-1.jpg)
Abstract
Objective The coronavirus disease 2019 pandemic accelerated the adoption of telehealth technologies. Persistent disparities in telecommunication devices, internet connectivity, and digital literacy, however, undermine the potential for telemedicine to reduce barriers to health care access. Health systems may have a role in addressing these structural inequities. We describe the operationalization and feasibility of an internet-enabled tablet loaner program at a freestanding children's hospital.
Methods Between October 2020 and October 2021, pediatricians enrolled families through ambulatory clinics at an academic urban freestanding children's hospital. Eligibility criteria included difficulty accessing virtual care due to lack of stable internet or device. Tablets featured an unlimited data package, access to the patient portal, and virtual visit platform. A private technology company managed device configuration and distribution. To characterize program impact, we compared the proportion of completed clinical encounters during the intervention compared with a preintervention period (March 2020–October 2020) and conducted a qualitative survey with program participants. Participant and visit characteristics were obtained from the electronic medical record and summarized with descriptive statistics.
Results A total of 111 families participated in the tablet loaner program, the majority of whom were Hispanic (51.4%) and black, non-Hispanic (26.1%), and publicly insured (64.9%). Between the preintervention and intervention periods, there was a significant increase in completed video- and phone-based virtual visits (75.3 vs. 79.1%, p = 0.038). The proportion of video-based only visits increased from 82.9 to 88.9%. p < 0.001. Families reported that the tablet improved the patient's ability to receive medical care (93.7%) and was easy to use (93.9%).
Conclusion The tablet loaner initiative was associated with an improvement in markers of virtual visit engagement and health care experience. Efforts to expand telemedicine equity must consider technological access and digital literacy as well as broad coalitions across industry, government, and community organizations.
Keywords
at-risk populations - telemedicine - telehealth - socioeconomic disparities - outcomes - implementation model - children - internet - technologyProtection of Human and Animal Subjects
The study was performed in compliance with the World Medical Association Declaration of Helsinki on Ethical Principles for Medical Research Involving Human Subjects and was deemed to be exempt from Boston Children's Hospital Institutional Review Board approval.
Publication History
Received: 13 October 2022
Accepted: 17 January 2023
Accepted Manuscript online:
20 January 2023
Article published online:
12 April 2023
© 2023. Thieme. All rights reserved.
Georg Thieme Verlag KG
Rüdigerstraße 14, 70469 Stuttgart, Germany
-
References
- 1 Mann DM, Chen J, Chunara R, Testa PA, Nov O. COVID-19 transforms health care through telemedicine: evidence from the field. J Am Med Inform Assoc 2020; 27 (07) 1132-1135
- 2 Gergen Barnett K, Mishuris RG, Williams CT. et al. Telehealth's double-edged sword: bridging or perpetuating health inequities?. J Gen Intern Med 2022; 37 (11) 2845-2848
- 3 Merid B, Robles MC, Nallamothu BK. Digital redlining and cardiovascular innovation. Circulation 2021; 144 (12) 913-915
- 4 Gunaratnam Y. Researching Race and Ethnicity: Methods, Knowledge, and Power. Sage Publications; 2003
- 5 Graetz I, Gordon N, Fung V, Hamity C, Reed ME. The digital divide and patient portals: internet access explained differences in patient portal use for secure messaging by age, race, and income. Med Care 2016; 54 (08) 772-779
- 6 Di Tosto G, Walker DM, Sieck CJ. et al. Examining the relationship between health literacy, health numeracy, and patient portal use. Appl Clin Inform 2022; 13 (03) 692-699
- 7 Pierce RP, Stevermer JJ. Disparities in use of telehealth at the onset of the COVID-19 public health emergency. J Telemed Telecare 2023; 29 (01) 3-9
- 8 Waseem N, Boulanger M, Yanek LR, Feliciano JL. Disparities in telemedicine success and their association with adverse outcomes in patients with thoracic cancer during the COVID-19 pandemic. JAMA Netw Open 2022; 5 (07) e2220543
- 9 Brociner E, Yu KH, Kohane IS, Crowley M. Association of race and socioeconomic disadvantage with missed telemedicine visits for pediatric patients during the COVID-19 pandemic. JAMA Pediatr 2022; 176 (09) 933-935
- 10 Chang JE, Lindenfeld Z, Albert SL. et al. Telephone vs. video visits during COVID-19: safety-net provider perspectives. J Am Board Fam Med 2021; 34 (06) 1103-1114
- 11 Jelinek R, Pandita D, Linzer M, Engoang JBBN, Rodin H. An evidence-based roadmap for the provision of more equitable telemedicine. Appl Clin Inform 2022; 13 (03) 612-620
- 12 Eruchalu CN, Pichardo MS, Bharadwaj M. et al. The expanding digital divide: digital health access inequities during the COVID-19 pandemic in New York City. J Urban Health 2021; 98 (02) 183-186
- 13 Verizon. Explore Verizon 5G and 4G LTE Network Coverage in Your Area. Accessed February 6, 2023 at: https://www.verizon.com/coverage-map/
- 14 Ramsetty A, Adams C. Impact of the digital divide in the age of COVID-19. J Am Med Inform Assoc 2020; 27 (07) 1147-1148
- 15 Muvuka B, Combs RM, Ayangeakaa SD, Ali NM, Wendel ML, Jackson T. Health literacy in African-American communities: barriers and strategies. Health Lit Res Pract 2020; 4 (03) e138-e143
- 16 Vollbrecht H, Arora V, Otero S, Carey K, Meltzer D, Press VG. Evaluating the need to address digital literacy among hospitalized patients: cross-sectional observational study. J Med Internet Res 2020; 22 (06) e17519
- 17 Eyrich NW, Andino JJ, Fessell DP. Bridging the digital divide to avoid leaving the most vulnerable behind. JAMA Surg 2021; 156 (08) 703-704
- 18 Zulman DM, Wong EP, Slightam C. et al. Making connections: nationwide implementation of video telehealth tablets to address access barriers in veterans. JAMIA Open 2019; 2 (03) 323-329
- 19 U.S. Department of Commerce. Biden-Harris Administration Launches $45 Billion “Internet for All” Initiative to Bring Affordable, Reliable High-Speed Internet to Everyone in America.; 2022. Accessed February 6, 2023 at: https://www.commerce.gov/news/press-releases/2022/05/biden-harris-administration-launches-45-billion-internet-all-initiative
- 20 Moen M, Storr C, German D, Friedmann E, Johantgen M. A review of tools to screen for social determinants of health in the United States: a practice brief. Popul Health Manag 2020; 23 (06) 422-429
- 21 Gaughan AA, Walker DM, Sova LN, Vink S, Moffatt-Bruce SD, McAlearney AS. Improving provisioning of an inpatient portal: perspectives from nursing staff. Appl Clin Inform 2022; 13 (02) 355-362