Disparities in Orthopaedic Care Persist with Telemedicine
Like other medical specialties at the start of the COVID-19 pandemic, orthopaedic surgery rapidly pivoted from in-person visits to remote appointments via telemedicine. Analysis of that initial experience finds that some groups of patients faced persistent or worsening disparities as the shift to telemedicine occurred, according to an article published online ahead of print by Clinical Orthopaedics and Related Research (CORR).
“We found concerning disparities in access to orthopaedic care via telemedicine for patients, and we observed that those disparities were associated with race or ethnicity, primary language, and insurance status,” the authors said.
Telemedicine has the potential to improve healthcare access for hard-to-reach populations. But there are concerns that growing reliance on telemedicine might perpetuate or even worsen existing healthcare disparities – for example, adding new barriers for non-English speakers or people without computers and high-speed internet.
The researchers, from Brigham & Women’s Hospital/Harvard Medical School, studied these disparities by comparing virtual and in-person orthopaedic patient experiences. The study included nearly 2000 patients who had received orthopaedic care via telemedicine at 2 Boston medical centers between March and May 2020 and nearly 10,000 patients who had in-person orthopaedic visits between March and May 2019.
The telemedicine patients were slightly younger than those making in-person visits the previous year (average 56 versus 59 years). In analyses adjusting for this and other differences, disparities remained significant in 3 areas:
- Race/ethnicity. The odds that a Latino patient would be seen by telemedicine during the pandemic were 41% lower than for a white patient, and the odds that an Asian patient would be seen via telemedicine were 27% lower than for a white patient.
- Language. Patients whose primary language was not English or Spanish had one-third the odds of making a telemedicine visit than did an English-language speaker. There was no difference in the rate of telemedicine visits for Spanish versus English speakers.
- Insurance. The odds of a patient with Medicaid coverage receiving a telemedicine evaluation during the early months of the pandemic were 13% lower than for a patient with commercial insurance.
The researchers said the following measures would help to ensure access to telemedicine systems:
- Target minority and low-income communities
- Address the needs of patients who lack computer access
- Ensure that telemedicine is eligible for reimbursement
- Provide expanded hours and interpreter services for telemedicine visits
In an accompanying Take 5 interview, senior author Andrew J. Schoenfeld, MD, MSc, and CORR’s Editor-in-Chief Seth S. Leopold, MD agree that telemedicine will remain part of the healthcare landscape long after the pandemic is over. “I would hope that we can find ways to use new tools to mitigate, rather than exacerbate, healthcare disparities,” Dr. Leopold said.
When it comes to developing and ensuring equitable access to telemedicine systems, “I think the onus is on the healthcare organizations, not civic government,” Dr. Schoenfeld said. “The funding, advertising, and infrastructure to support this would ideally come from the healthcare organization itself, who could partner with leaders, grassroots organizations, and community stakeholders to ensure members of the community are aware of telemedicine and have the ability to access the technology.”
Xiong G, Green NE, Lightsey HM IV, et al. Telemedicine use in orthopaedic surgery varies by race, ethnicity, primary language, and insurance status. Clin Orthop Relat Res. 10 May 2021. Online ahead of print. DOI: 10.1097/CORR.0000000000001775