Access to telehealth is severely lacking for some Massachusetts populations, research finds

With an unprecedented uptick in mental illnesses amplified by the COVID-19 pandemic, telehealth usage spiked when in-person care was not available. But new research shows a stark disparity in access to telehealth services among different populations across Massachusetts. Researchers found that those who are of lower socioeconomic status, seniors, children and those living in rural areas are less likely to use telehealth services. These findings highlight what's known as the "digital divide."

Dr. Alon Peltz, lead researcher of the study and assistant professor of the Department of Population Medicine at Harvard Medical School, and Barbra Rabson, president and CEO of Massachusetts Health Quality Partners, the non-profit that collaborated on the study, joined All Things Considered host Arun Rath to take a deep dive into the digital divide. This transcript has been edited lightly.

Arun Rath: It's sort of fascinating because obviously we talked about a digital divide years before the pandemic hit, but the pandemic really revealed how it's a public health issue.

Dr. Alon Peltz: So well said. Absolutely. When March 2020 arrived, we really turned so much health care into the virtual space and the digital divide that has existed across all spheres of life, I think, really proved how much it still exists in health care. We know telehealth is so dependent on people having the devices, knowing how to use those devices in health care and being able to afford them to have high-quality connections.

And then, at the provider side, there is an immense mobilization in response to the pandemic that was so critical by health plans, by government officials, by providers to overnight transform the healthcare delivery system. So we should absolutely celebrate how much was done to make telehealth a viable option for people to continue receiving critical care and, at the same time, figure out what are some ways we can really make progress that closing those divides across communities and across populations.

Rath: And Barbra, again, this is a problem that we knew existed. What was it that made you think that we needed more data about this to understand this better?

Barbra Rabson: When COVID hit, we found patients at a time when they were the most vulnerable; First, they were not getting access to care. And so, as Alon mentioned, they mobilized extremely quickly. And what we were able to do in this study, which was done after the pandemic started, was that we looked at communities that had lower utilization of telehealth. By that, we dove in and we looked at not only the claims about the services that were used, but also we interviewed patients, providers and community leaders in those cities where telehealth utilization was lower, and we were able to find out more about the barriers.

One of the most striking barriers was that patients who did not have a usual primary care clinician did not have access to telehealth, because telehealth visits got scheduled through their primary care clinicians. Without having that relationship, that wasn't even an option for them. So if you had no usual source of care, you couldn't call in and say, "Look, I can't come in because I'm sick or clinics are closed, but is there a way for me to get advice?" And so those patients were shut out of telehealth early on.

Rath: Tell us a bit more about how this plays out on the individual patient level, how it affects care for people.

Rabson: We're all individual people, so people react very differently to telehealth — both patients and clinicians. In some cases, patients absolutely want to be seen in-person, in the clinician's office. And this is often, you know, the elder population is much more comfortable with this if they're not comfortable with the technology. On the other hand, many, you know, elders and all kinds of people took to the technology very quickly. So it was really — one of the striking things was how individualized this was in terms of both patients and clinicians, and their response to telehealth.

What telehealth allowed is for patients to be seen in their own homes. And this was a wonderful advantage because of the convenience factor, patients who had, for whatever reason, it was difficult to get into the office or they were very concerned for their own safety. It also allowed clinicians to see patients in their home setting, which was a real benefit in many cases.

Rath: You know, something that struck me was children are also seemingly left out from this. It's just kind of sad because we, you know, we sort of thought that telehealth worked really well, and remote learning didn't. But in terms of telehealth, it seems that kids are also somehow getting left out of that. Can you talk about that?

Peltz: That's an excellent point. I am a pediatrician and a researcher and a parent and think about this issue a lot from different perspectives.

I think, overall, telehealth has become a new tool for us to be able to deliver care and deliver care in a way that adds value to parents and the children. That's been really critical. But at the same time, I'll go back to a point that Barbra made, which is individual preference is so important. The context really matters. For some situations, telehealth for children can be an incredible tool. It can save a long trip on a bus to the pediatrician's office when your little one is sick.

At the same time, pediatrician visits can be really challenging by telehealth. If you're trying to find ways to do a developmental assessment and a behavioral assessment or physical examination through Zoom, and a lot of child health does involve that direct, human relationship with the patient and the child. And so I think we're seeing parts of that play out.

The levels of telehealth use for children have been about half those rates compared to that of the adults. And so there's definitely some opportunity to figure out, is that just a response to what parents are voicing as their preference? Or are there opportunities for us in the provider community to rise up and meet more of those opportunities to deliver care virtually?

Rath: That's Dr. Alan Peltz. He's the lead researcher of a study that reveals a stark disparity in access to telehealth services among different populations in Massachusetts. Dr. Peltz, it's been great speaking with you about this very important issue. Thank you.