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Health Care Delivery Models

Disparities in Use of Video Telemedicine Among Patients With Limited English Proficiency During the COVID-19 Pandemic

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To identify the key insights or developments described in this article

1 Credit CME

JAMA Network Open

Published Online: November 4, 2021

Research Letter

Article Information and Disclosures

Loretta Hsueh, PhD¹;

Jie Huang, PhD¹;

Andrea K. Millman, MA¹;

Anjali Gopalan, MD¹;

Rahul K. Parikh, MD²;

Silvia Teran, MD²;

Mary E. Reed, DrPH¹

Author Affiliations

¹Division of Research, Kaiser Permanente Northern California, Oakland
²The Permanente Medical Group, Oakland, California

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Telemedicine expands health care access for patients facing barriers to in-person care,¹ but may also inadvertently widen existing care disparities²^,3 for the 25 million people living in the US with limited English proficiency (LEP)⁴ because of overlapping low digital literacy and health literacy.⁵ Data on differential video vs telephone visit use by patients with LEP are needed to inform telemedicine equity strategies. In patients self-scheduling a primary care visit during the COVID-19 pandemic, we hypothesized that LEP would be associated with lower video use compared with telephone, especially among patients without prior video visit experience.

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Article Information

Accepted for Publication: September 9, 2021.

Published: November 4, 2021. doi:10.1001/jamanetworkopen.2021.33129

Open Access: This is an open access article distributed under the terms of the CC-BY License. © 2021 Hsueh L et al. JAMA Network Open.

Corresponding Author: Loretta Hsueh, PhD, Division of Research, Kaiser Permanente Northern California, 2000 Broadway, Oakland, CA 94612 (Loretta.Hsueh@kp.org).

Author Contributions: Drs Hsueh and Huang had full access to all of the data in the study and take responsibility for the integrity of the data and the accuracy of the data analysis.

Concept and design: Hsueh, Parikh, Reed.

Acquisition, analysis, or interpretation of data: Hsueh, Huang, Millman, Gopalan, Teran, Reed.

Drafting of the manuscript: Hsueh.

Critical revision of the manuscript for important intellectual content: Huang, Millman, Gopalan, Parikh, Teran, Reed.

Statistical analysis: Hsueh, Huang, Reed.

Obtained funding: Reed.

Administrative, technical, or material support: Millman, Parikh, Reed.

Supervision: Reed.

Conflict of Interest Disclosures: Ms Millman reported receiving grants from the Agency for Healthcare Research and Quality during the conduct of the study. Dr Reed reported receiving grants from the Agency for Healthcare Research and Quality and the National Institutes of Health during the conduct of the study. No other disclosures were reported.

Funding/Support: Dr Hsueh reported receiving support from the The Permanente Medical Group Delivery Science Fellowship program. This study was funded by the Agency for Healthcare Research and Quality (grant R01HS25189).

Role of the Funder/Sponsor: The funders had no role in the design and conduct of the study; collection, management, analysis, and interpretation of the data; preparation, review, or approval of the manuscript; and decision to submit the manuscript for publication.

References

Reed ME , Parikh R , Huang J , Ballard DW , Barr I , Wargon C . Real-time patient–provider video telemedicine integrated with clinical care. N Engl J Med. 2018;379(15):1478-1479. doi:10.1056/NEJMc1805746 PubMed Google Scholar Crossref

Nouri S , Khoong EC , Lyles CR , Karliner L . Addressing equity in telemedicine for chronic disease management during the COVID-19 pandemic. NEJM Catal Innov Care Deliv. 2020;1(3). doi:10.1056/CAT.20.0123 Google Scholar

Ye S , Kronish I , Fleck E , et al. Telemedicine expansion during the COVID-19 pandemic and the potential for technology-driven disparities. J Gen Intern Med. 2021;36(1):256-258. doi:10.1007/s11606-020-06322-y PubMed Google Scholar Crossref

Zeigler K , Camarota S. 67.3 Million in the United States Spoke a Foreign Language at Home in 2018. Center for Immigration Studies. 2019.

Nouri SS , Avila-Garcia P , Cemballi AG , Sarkar U , Aguilera A , Lyles CR . Assessing mobile phone digital literacy and engagement in user-centered design in a diverse, safety-net population: mixed methods study. JMIR Mhealth Uhealth. 2019;7(8):e14250. doi:10.2196/14250 PubMed Google Scholar

AMA CME Accreditation Information

Credit Designation Statement: The American Medical Association designates this Journal-based CME activity activity for a maximum of 1.00  AMA PRA Category 1 Credit(s)™. Physicians should claim only the credit commensurate with the extent of their participation in the activity.

Successful completion of this CME activity, which includes participation in the evaluation component, enables the participant to earn up to:

1.00 Medical Knowledge MOC points in the American Board of Internal Medicine's (ABIM) Maintenance of Certification (MOC) program;;
1.00 Self-Assessment points in the American Board of Otolaryngology – Head and Neck Surgery’s (ABOHNS) Continuing Certification program;
1.00 MOC points in the American Board of Pediatrics’ (ABP) Maintenance of Certification (MOC) program;
1.00 Lifelong Learning points in the American Board of Pathology’s (ABPath) Continuing Certification program; and
1.00 CME points in the American Board of Surgery’s (ABS) Continuing Certification program

It is the CME activity provider's responsibility to submit participant completion information to ACCME for the purpose of granting MOC credit.