A Medical Student-Led Multipronged Initiative to Close the Digital Divide in Outpatient Primary Care

Abstract

Background The coronavirus disease 2019 pandemic accelerated the use of telehealth. However, this also exacerbated health care disparities for vulnerable populations.

Objectives This study aimed to explore the feasibility and effectiveness of a medical student-led initiative to identify and address gaps in patient access to digital health resources in adult primary care clinics at an academic safety-net hospital.

Methods Medical students used an online HIPAA-compliant resource directory to screen for digital needs, connect patients with resources, and track outcome metrics. Through a series of Plan-Do-Study-Act (PDSA) cycles, the program grew to offer services such as information and registration for subsidized internet and phone services via the Affordable Connectivity Program (ACP) and Lifeline, assistance setting up and utilizing MyChart (an online patient portal for access to electronic health records), orientation to telehealth applications, and connection to community-based digital literacy training.

Results Between November 2021 and March 2023, the program received 608 assistance requests. The most successful intervention was MyChart help, resulting in 83% of those seeking assistance successfully signing up for MyChart accounts and 79% feeling comfortable navigating the portal. However, subsidized internet support, digital literacy training, and telehealth orientation had less favorable outcomes. The PDSA cycles highlighted numerous challenges such as inadequate patient outreach, time-consuming training, limited in-person support, and unequal language assistance. To overcome these barriers, the program evolved to utilize clinic space for outreach, increase flier distribution, standardize training, and enhance integration of multilingual resources.

Conclusion This study is, to the best of our knowledge, the first time a medical student-led initiative addresses the digital divide with a multipronged approach. We outline a system that can be implemented in other outpatient settings to increase patients' digital literacy and promote health equity, while also engaging students in important aspects of nonclinical patient care.

Keywords

telehealth and telemedicine - patient portal - social determinants of health - health equity - digital literacy

Protection of Human and Animal Subjects

A qualified member of our Institutional Review Board staff reviewed and determined that our initiative qualifies for an exemption determination under the policies and procedures of the Human Research Protection Program under the category of Quality Improvement.

^* These authors contributed equally to this work.

Publication History

Received: 06 March 2024

Accepted: 20 July 2024

Accepted Manuscript online:
22 July 2024

Article published online:
09 October 2024

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