Teleneurology and Health Disparities

Altaf Saadi; Adys Mendizabal; Nicte I. Mejia

doi:10.1055/s-0041-1742194

Seminars in Neurology, Table of Contents

Semin Neurol 2022; 42(01): 060-066
DOI: 10.1055/s-0041-1742194

Review Article

Teleneurology and Health Disparities

Authors

Altaf Saadi

¹Department of Neurology, Massachusetts General Hospital, Boston, Massachusetts

²Harvard Medical School, Boston, Massachusetts
Adys Mendizabal

³Department of Neurology, University of California Los Angeles, Los Angeles, California
Nicte I. Mejia

¹Department of Neurology, Massachusetts General Hospital, Boston, Massachusetts

²Harvard Medical School, Boston, Massachusetts

Abstract

The disparate access to, and use of, telemedicine reflects those of in-person health. These disparities are perpetuated as a result of individual, social, and structural factors like low digital literacy, unequal availability of broadband services, and systemic racism. This review focuses on extant literature on disparities in teleneurology, including racial or ethnic disparities, language inequities, and the global context. Understanding social and structural barriers to equitable access to quality teleneurology is critical to addressing and preventing health disparities, ensuring effective and equitable neurological care for all patients.

Keywords

teleneurology - telemedicine - racial or ethnic disparities

Full Text

References

References
1 Levine SR, Gorman M. “Telestroke”: the application of telemedicine for stroke. Stroke 1999; 30 (02) 464-469
2 Schwamm LH, Chumbler N, Brown E. et al; American Heart Association Advocacy Coordinating Committee. Recommendations for the implementation of telehealth in cardiovascular and stroke care: a policy statement from the American Heart Association. Circulation 2017; 135 (07) e24-e44
3 Schwamm LH, Holloway RG, Amarenco P. et al; American Heart Association Stroke Council, Interdisciplinary Council on Peripheral Vascular Disease. A review of the evidence for the use of telemedicine within stroke systems of care: a scientific statement from the American Heart Association/American Stroke Association. Stroke 2009; 40 (07) 2616-2634
4 Beck CA, Beran DB, Biglan KM. et al; Connect.Parkinson Investigators. National randomized controlled trial of virtual house calls for Parkinson disease. Neurology 2017; 89 (11) 1152-1161
5 Guidon AC, Muppidi S, Nowak RJ. et al. Telemedicine visits in myasthenia gravis: expert guidance and the Myasthenia Gravis Core Exam (MG-CE). Muscle Nerve 2021; 64 (03) 270-276
6 Wilson AM, Jamal NI, Cheng EM. et al. Teleneurology clinics for polyneuropathy: a pilot study. J Neurol 2020; 267 (02) 479-490
7 Howard IM, Kaufman MS. Telehealth applications for outpatients with neuromuscular or musculoskeletal disorders. Muscle Nerve 2018; 58 (04) 475-485
8 Maresca G, De Cola MC, Caliri S. et al; Sicilian Teleneurology Group. Moving towards novel multidisciplinary approaches for improving elderly quality of life: the emerging role of telemedicine in Sicily. J Telemed Telecare 2019; 25 (05) 318-324
9 Ross L, Bena J, Bermel R. et al. Implementation and patient experience with outpatient subspecialty teleneurology visits at a single academic institution over four years (Plen01.004). Neurology 2019;92(15, Suppl). Accessed December 12, 2019 at: https://n.neurology.org/content/92/15_Supplement/Plen01.004
10 Almallouhi E, Al Kasab S, Harvey JB. et al. Teleneurology network to improve access to neurologists for patients in rural areas: a real-world experience. Telemed J E Health 2020; 26 (01) 110-113
11 Saadi A, Mateen FJ. International issues: teleneurology in humanitarian crises: lessons from the Médecins Sans Frontières experience. Neurology 2017; 89 (03) e16-e19
12 Wechsler LR. Advantages and limitations of teleneurology. JAMA Neurol 2015; 72 (03) 349-354
13 Strowd RE, Strauss L, Graham R. et al. Rapid implementation of outpatient teleneurology in rural Appalachia: barriers and disparities. Neurol Clin Pract 2021; 11 (03) 232-241
14 Davis LE, Harnar J, LaChey-Barbee LA, Pirio Richardson S, Fraser A, King MK. Using teleneurology to deliver chronic neurologic care to rural veterans: analysis of the first 1,100 patient visits. Telemed J E Health 2019; 25 (04) 274-278
15 Bronson DL, Centor RM, Gluckman RA. et al. Racial and ethnic disparities in health care updated 2010. A Position Paper of the American College of Physicians. 2010. . Accessed June 21, 2021 at https://www.acponline.org/system/files/documents/advocacy/current_policy_papers/assets/racial_disparities.pdf
16 Saadi A, Himmelstein DU, Woolhandler S, Mejia NI. Racial disparities in neurologic health care access and utilization in the United States. Neurology 2017; 88 (24) 2268-2275
17 Marulanda-Londoño ET, Bell MW, Hope OA. et al. Reducing neurodisparity: recommendations of the 2017 AAN Diversity Leadership Program. Neurology 2019; 92 (06) 274-280
18 Braveman P, Gottlieb L. The social determinants of health: it's time to consider the causes of the causes. Public Health Rep 2014; 129 (Suppl. 02) 19-31
19 Bailey ZD, Krieger N, Agénor M, Graves J, Linos N, Bassett MT. Structural racism and health inequities in the USA: evidence and interventions. Lancet 2017; 389 (10077): 1453-1463
20 Bailey ZD, Feldman JM, Bassett MT. How structural racism works - racist policies as a root cause of U.S. racial health inequities. N Engl J Med 2021; 384 (08) 768-773
21 Rodriguez JA, Lipsitz SR, Lyles CR, Samal L. Association between patient portal use and broadband access: a national evaluation. J Gen Intern Med 2020; 35 (12) 3719-3720
22 Pierce RP, Stevermer JJ. Disparities in use of telehealth at the onset of the COVID-19 public health emergency. J Telemed Telecare 2020; X20963893
23 Nolen L, Mejia NI. Inequities in neurology amplified by the COVID-19 pandemic. Nat Rev Neurol 2021; 17 (02) 67-68
24 Rodriguez JA, Betancourt JR, Sequist TD, Ganguli I. Differences in the use of telephone and video telemedicine visits during the COVID-19 pandemic. Am J Manag Care 2021; 27 (01) 21-26
25 Uscher-Pines L, Sousa J, Jones M. et al. Telehealth use among safety-net organizations in California during the COVID-19 pandemic. JAMA 2021; 325 (11) 1106-1107
26 McGinley MP, Gales S, Rowles W. et al. Expanded access to multiple sclerosis teleneurology care following the COVID-19 pandemic. Mult Scler J Exp Transl Clin 2021; 7 (01) 2055217321997467
27 Smith CB, Bhardwaj AS. Disparities in the use of telehealth during the COVID-19 pandemic. J Clin Oncol 2020; 38 (29) 87
28 Darrat I, Tam S, Boulis M, Williams AM. Socioeconomic disparities in patient use of telehealth during the coronavirus disease 2019 surge. JAMA Otolaryngol Head Neck Surg 2021; 147 (03) 287-295
29 George SM, Hamilton A, Baker R. Pre-experience perceptions about telemedicine among African Americans and Latinos in South Central Los Angeles. Telemed J E Health 2009; 15 (06) 525-530
30 Shavers VL, Lynch CF, Burmeister LF. Knowledge of the Tuskegee study and its impact on the willingness to participate in medical research studies. J Natl Med Assoc 2000; 92 (12) 563-572
31 Kennedy BR, Mathis CC, Woods AK. African Americans and their distrust of the health care system: healthcare for diverse populations. J Cult Divers 2007; 14 (02) 56-60
32 Saadi A, Rodriguez JA. Addressing Privacy Concerns Central to Success of Telehealth Use among Undocumented Immigrants | Health Affairs Blog. Health Affairs Blog. Published November 23, 2020. Accessed June 21, 2021 at: https://www.healthaffairs.org/do/10.1377/hblog20201118.621497/full/
33 Pekmezaris R, Williams MS, Pascarelli B. et al. Adapting a home telemonitoring intervention for underserved Hispanic/Latino patients with type 2 diabetes: an acceptability and feasibility study. BMC Med Inform Decis Mak 2020; 20 (01) 324
34 Demographics of Internet and Home Broadband Usage in the United States | Pew Research Center. Accessed June 18, 2021 at: https://www.pewresearch.org/internet/fact-sheet/internet-broadband/?menuItem=194b49c6-68e6-45f0-902a-575673edb17f
35 Tappen RM, Cooley ME, Luckmann R, Panday S. Digital health information disparities in older adults: a mixed methods study. J Racial Ethn Health Disparities 2021; (epub ahead of print)
36 Chunara R, Zhao Y, Chen J. et al. Telemedicine and healthcare disparities: a cohort study in a large healthcare system in New York City during COVID-19. J Am Med Inform Assoc 2021; 28 (01) 33-41
37 Mayberry LS, Lyles CR, Oldenburg B, Osborn CY, Parks M, Peek ME. mHealth interventions for disadvantaged and vulnerable people with type 2 diabetes. Curr Diab Rep 2019; 19 (12) 148
38 Divi C, Koss RG, Schmaltz SP, Loeb JM. Language proficiency and adverse events in US hospitals: a pilot study. Int J Qual Health Care 2007; 19 (02) 60-67
39 Cohen AL, Rivara F, Marcuse EK, McPhillips H, Davis R. Are language barriers associated with serious medical events in hospitalized pediatric patients?. Pediatrics 2005; 116 (03) 575-579
40 Rawal S, Srighanthan J, Vasantharoopan A, Hu H, Tomlinson G, Cheung AM. Association between limited English proficiency and revisits and readmissions after hospitalization for patients with acute and chronic conditions in Toronto, Ontario, Canada. JAMA 2019; 322 (16) 1605-1607
41 Luan Erfe BM, Siddiqui KA, Schwamm LH, Kirwan C, Nunes A, Mejia NI. Professional medical interpreters influence the quality of acute ischemic stroke care for patients who speak languages other than English. J Am Heart Assoc 2017; 6 (09) 1-8
42 Chen AH, Youdelman MK, Brooks J. The legal framework for language access in healthcare settings: Title VI and beyond. J Gen Intern Med 2007; 22 (Suppl. 02) 362-367
43 Title VI. Prohibition Against National Origin Discrimination Affecting Limited English Proficient Persons | National Archives. Accessed June 17, 2021 at: https://www.archives.gov/eeo/laws/title-vi.html
44 Diamond LC, Schenker Y, Curry L, Bradley EH, Fernandez A. Getting by: underuse of interpreters by resident physicians. J Gen Intern Med 2009; 24 (02) 256-262
45 Rodriguez JA, Saadi A, Schwamm LH, Bates DW, Samal L. Disparities in telehealth use among California patients with limited English proficiency. Health Aff (Millwood) 2021; 40 (03) 487-495
46 Children Living in Households with a Broadband-Connected Device, by Household English Proficiency - Kidsdata.org. Accessed June 18, 2021 at: https://www.kidsdata.org/topic/2218/broadband-english-proficiency/table#fmt=2768&loc=2,127,1657,331,1761,171,2168,345,357,324,369,362,360,2076,364,356,217,354,1663,339,2169,365,343,367,344,366,368,265,349,361,4,273,59,370,326,341,338,350,2145,359,363,340&tf=108&ch=1475,1476
47 Rodriguez JA, Davis RB, Percac-Lima S. Non-English language availability of community health center websites. Med Care 2019; 57 (6, Suppl 6; Suppl 2): S121-S126
48 Ku L, Freilick A. Caring for Immigrants: Health Care Safety Nets in Los Angeles, New York, Miami, and Houston. 2001 . The Urban Institute, Washington, DC. Accessed June 21, 2021 at https://aspe.hhs.gov/reports/caring-immigrants-health-care-safety-nets-los-angeles-new-york-miami-houston.
49 Bower JH, Zenebe G. Neurologic services in the nations of Africa. Neurology 2005; 64 (03) 412-415
50 Qiang CZ, Yamamichi M, Hausman V, Miller R, Altman D. Mobile Applications for the Health Sector. World Bank Group; 2012: 98
51 WHO Global Observatory for eHealth, World Health Organization. MHealth: New Horizons for Health through Mobile Technologies. World Health Organization; 2011. Accessed July 1, 2021 at: http://www.who.int/goe/publications/goe_mhealth_web.pdf
52 Constanzo F, Aracena-Sherck P, Peña L. et al. Characterization of the teleneurology patients at the Hospital Las Higueras de Talcahuano-Chile. Front Neurol 2020; 11: 595577
53 Constanzo F, Aracena-Sherck P, Hidalgo JP. et al. Contribution of a synchronic teleneurology program to decrease the patient number waiting for a first consultation and their waiting time in Chile. BMC Med Inform Decis Mak 2020; 20 (01) 20
54 Sarfo FS, Adamu S, Awuah D, Ovbiagele B. Tele-neurology in sub-Saharan Africa: a systematic review of the literature. J Neurol Sci 2017; 380: 196-199
55 McKenzie ED, Lim ASP, Leung ECW. et al. Validation of a smartphone-based EEG among people with epilepsy: a prospective study. Sci Rep 2017; 7: 45567
56 Williams JA, Cisse FA, Schaekermann M. et al; Guinea Epilepsy Project. Smartphone EEG and remote online interpretation for children with epilepsy in the Republic of Guinea: quality, characteristics, and practice implications. Seizure 2019; 71: 93-99
57 Patterson V, Hoque F, Vassallo D, Farquharson Roberts M, Swinfen P, Swinfen R. Store-and-forward teleneurology in developing countries. J Telemed Telecare 2001; 7 (1, Suppl 1): 52-53
58 Mehrotra A, Nimgaonkar A, Richman B. Telemedicine and medical licensure - potential paths for reform. N Engl J Med 2021; 384 (08) 687-690
59 Wheeler T. 5 steps to get the internet to all Americans. Brookings Institute Blog. Published May 27, 2020. Accessed July 1, 2021 at: https://www.brookings.edu/research/5-steps-to-get-the-internet-to-all-americans/
60 O'Kula SS, Aamodt WW, Rubenstein MN. Global & community health: neurologic care for Latinos in South Philadelphia: global health at home. Neurology 2019; 93 (10) 461-462
61 McCormick R, Estrada J, Whitney C. et al. Teleneurology comprehensive inpatient consultations expedite access to care and decreases hospital length of stay. Neurohospitalist 2021; 11 (03) 229-234
62 Peyton L. How a Houston church partnered with UH to bring a new telehealth clinic to the community. Houston Chronicle Published September 2, 2021. Accessed December 3, 2021. https://www.houstonchronicle.com/lifestyle/houston-belief/article/How-a-Houston-church-partnered-with-UH-to-bring-a-16428715.php
63 Hughes HK, Hasselfeld BW, Cooper LA, Thornton RLJ, Commodore-Mensah Y. A process for developing a telehealth equity dashboard at a large academic health system serving diverse populations. J Health Care Poor Underserved 2021; 32 (02) 198-210
64 Tatum WO, Hirsch LJ, Gelfand MA. et al; OSmartViE Investigators. Assessment of the predictive value of outpatient smartphone videos for diagnosis of epileptic seizures. JAMA Neurol 2020; 77 (05) 593-600
65 Sharma AE, Khoong EC, Nijagal MA. et al. Clinician experience with telemedicine at a safety-net hospital network during COVID-19: a cross-sectional survey. J Health Care Poor Underserved 2021; 32 (02) 220-240
66 COVID Pay Gap: Paid leave for Blacks, Latinos means job, pay losses. Accessed June 18, 2021 at: https://www.usatoday.com/story/money/2021/03/19/paid-leave-shortfall-during-covid-means-job-pay-losses/4730902001/
67 Srinivasan Malathi, Jayant P, Zulman Donna. et al. Enhancing patient engagement during virtual care: A conceptual model and rapid implementation at an academic medical center. NEJM Catalyst Innovations in Care Delivery Published online July 10, 2020. Accessed December 3, 2021. https://catalyst.nejm.org/doi/full/10.1056/CAT.20.0262