Introduction
A new era of telehealth has begun as a result of the COVID-19 pandemic. Prior to the COVID-19 epidemic, telemedicine was hardly ever used, accounting for fewer than 1% of Medicare primary care visits (Valdez et al., 2020). Despite the fact that telemedicine has boosted access to care, there are worries that its increased use, even after the pandemic has passed, could worsen health inequities, particularly among those that are impacted by the digital divide. People who live in rural areas, older persons, people of color, and those with poor socioeconomic position are regularly mentioned as affected populations. Racial and ethnic minorities are disproportionately represented in the population with low socioeconomic status, making them much more likely to face the effects of the digital divide although race has proven little independent association with it.
People with disabilities, a group frequently absent from frameworks focusing on health equity and the digital gap, are rarely the subject of concerns, nevertheless. Moreover, only 51 (2%) of all articles published in 2020 included low- and middle-income countries in their title or abstract (Reis et al., 2021). This demonstrates hat publication bias applies to telehealth but also that the particular relevance of telehealth for those contexts is not being highlighted globally. Furthermore, this stark disparity in the number of studies that have been published may also be an indication of how difficult it is to adopt telehealth as a public health strategy in low- and middle-income nations.
As such, there is still an urgent need to expressly take into account how changes in the ubiquity and widespread use of telehealth affect equality and health in general. This paper addresses the effects of telehealth and equality before, during and after the pandemic and provides its optimal role in the nearest future. By offering estimates of the effect of improved access to telehealth services on the general public, this research adds to the larger body of work on telecare. It adds to the body of knowledge on telehealth regulation by demonstrating how expanding access to telehealth services could help to slow the rise in hospital use rates.
Literature Review
There are recent studies on the effects of telehealth on people with various backgrounds and its general effectiveness. Valdez et al. (2020) has extended the definition of telehealth provided by the Office of the National Coordinator for Health IT. They recommend including the use of electronic information and telecommunications technologies for clinical health care delivery, health-related education, and public health initiatives. Nearly half of Medicare primary care appointments are now delivered via telehealth thanks to changes in policy made in response to the pandemic by use of this mechanism. Valdez et al. (2020) also address benefits of telehealth to people with disabilities. The drive toward telehealth will have varying degrees of positive and negative effects due to the diversity of the disability population. Widespread telehealth services may increase certain people’s access to and satisfaction with their healthcare. Prior to entering the clinical setting for in-person sessions, patients frequently must complete time-consuming preparation tasks.
People with a wide range of disabilities, including but not limited to those with mobility restrictions, neurological conditions, cognitive disabilities, and/or mental health conditions, may find it difficult to complete tasks like arranging accessible transportation, scheduling caregiver assistance, and visiting public places. Telehealth may allow some people to prevent everything from minor annoyances to serious dangers. In some situations, using telehealth in place of in-person visits might provide advantages for persons with disabilities, such as less transportation costs and easier access to specialists (Nadkarni et al., 2021). However, these advantages cannot be achieved and may even increase health inequalities within this population if telehealth technologies are not planned, put into practice, and contextualized within proper policies.
Socioeconomic disparities across areas and certain population groups limit access to the right tools and technology, which should be taken into account by telehealth legislation. Beyond socioeconomic variables, culture and user location also have an impact on technology usage trends. Internet users from privileged socioeconomic categories were more likely than those from underprivileged socioeconomic groups to participate in education and distance learning activities, according to the Brazilian ICT Panel’s research from 2020 to 2021. In Brazil, the third quarter of 2020 saw unemployment rates rise to 14.1 million (13.1%), while 5.9 million people are currently counted as displaced employees (Reis et al., 2021). Although a continuing decline in illiteracy rates to a margin of 6.6% in 2019, it still means that 11 million individuals do not have the fundamental abilities to read or write.
Several research, despite their limited extent, imply that having access to telehealth services may lessen the likelihood of subsequent hospital procedures. The readmission rates of patients engaged in the telehealth plan were 44% lower over 30 days and 38% lower over 90 days than those of patients not enrolled, according to Grecu and Sharma, (2019)’s analysis. While Franciosi et al., (2021) observed that telemedicine is associated with faster time to diagnosis and shorter length of hospitalization in newborns, Keihanian et al., (2020) reported that telehealth is associated with fewer emergency admission rates. Hospital readmissions for heart failure and other conditions reduced by 44% and 51%, respectively, when telecare services were introduced for the post-cardiac arrest care program, according to the Veterans Health Administration, which has been at the forefront of telecare deployment (Ohl et al., 2019). These findings gave rise to optimism that telehealth would enhance performance while reducing the surge in medical expenses. Twenty-two states and the District of Columbia passed legislation requiring commercial health insurance companies to pay for telehealth services between 1995 and 2014 as a result.
Another study of Couch et al., (2021) examined the effects of telehealth on patient attendance and revenue within an Aboriginal Community in Australia. The need for community members to be financially “sustainable” is growing, and they are being urged to diversify their sources of income while still offering patients high-quality care. According to the study’s findings, the organization benefited financially by offering telehealth services because there was an increase in income of 17% per appointment slot during the COVID-19 period (Couch et al., 2021). The organization covered the small one-time expenditures associated with setting up telehealth delivery as part of the larger asset enhancements required in response to COVID-19.
The creation of various telehealth technologies is mostly out of reach. For instance, many people with communication-related disabilities, such as those who are deaf, hard of hearing, deafblind, blind, low vision, and speech handicapped, as well as people with intellectual disabilities, continue to be unable to utilize video-based telehealth services. Similarly, a variety of persons, including some of those already mentioned and those who depend on assistive technology to communicate with technology-based systems, continue to be unable to use patient portals (Steinert et al., 2021). As a result, it’s crucial that software developers update the variety of telehealth technologies, both web-based and app-based, to ensure that they’re accessible and sensitive to the specific ways in which people with disabilities could include others in their healthcare. Designers must therefore take into account specific requirements for both usability and usefulness.
Despite the fact that about 9000 research on telecare trials and pilot studies have been published, the quality of the evidence base is still inadequate. O’Donnell et al., (2020) focused on the use of telecare by seniors and those with chronic illnesses, was able to locate 30 more observational studies with at least three participants in addition to three randomised controlled trials. Nearly two thirds of these investigations were conducted there. The authors came to the conclusion that automated vital sign monitoring and telephone follow-up by nurses (for improving clinical indicators and lowering health service usage) proved to be the most efficient telecare interventions, particularly those targeted at people with diabetes or heart disease. There was a dearth of data to evaluate the cost-effectiveness of initiatives.
Analysis of Options
Telehealth services could avert health deterioration, lower hospital admissions, and avoid expensive interventions like surgical procedures by ensuring early access to medical care. These attributes give rise to expectations that telemedicine can lower medical expenses. However, prior research has demonstrated that shifts in the services offered have traditionally resulted in a rise in the demand for medical care. Telehealth increases inequality as there are people who lack access to digital tools and services. Therefore, this paper suggests further research on policies related to the telehealth services. The research should look at whether policies that take into consideration people with low socioeconomic status are effective in healthcare deliver as opposed to other policies.
Recommendations
It is critical to define telehealth in the future research as there some aspects that should be controlled. For example, there is a need to distinguish between a pattern of telehealth usage where a patient is only pulling information from sources (e.g., one way access/exchange). Moreover, the differences of a pattern of two-way information exchange between a patient and providers that occurs over time also should be managed in the scholarly activity in the future. However, compared to a pattern that involves ongoing two-way contact between a patient and a care delivery team, the former telehealth pattern is simpler to design and deliver. Future work is also required in the domain of telehealth technologies and methods’ scalability.
After knowing the definition of what to consider as a usage of telehealth, better marshalling of the available evidence is needed to support investment in telehealth applications as a part of the ICT infrastructure. This is true both for demonstrating the efficacy of telehealth and for demonstrating the organizational contexts in which it will be most effective. Evidence from large-scale pilots, as well as from current mainstream implementations, calls for careful synthesis, paying particular attention to both clinical aspects and indicators relating to successful implementation in routine care: change management, human resources, organizational interfaces, financing needs, technology integration, and ethics for everyday practice. In further telehealth evaluation, it is crucial to adopt a complete approach to its socioeconomic effects; expenses associated with infrastructure and people for the health sector, as well as for social care systems and other services, should be included. Modeling can be used to determine the level of efficacy a telehealth investment needs to reach in order to be regarded worthwhile as well as the long-term expenses and benefits.
The “business case” for telehealth is frequently very different for different players in the health care system and beyond. Financial flows in the health and welfare systems must be critically assessed to determine whether they act as an incentive or disincentive for the provision of telehealth services. Medical-legal and regulatory frameworks may present significant obstacles to the use of telehealth. The regulatory structure in many jurisdictions is not well suited to the unique qualities of these new services. To find best practices and chances for regulatory and legislative reform, it is important to compare the various regimes. By doing so, one can use telehealth to achieve the best possible societal benefits.
If telehealth is to be designed and implemented in fully accessible ways, it is essential to consider the potentially harmful unintended consequences for people with disabilities that may arise from widespread use of telehealth, even if all accessibility needs are met. This is true even for those for whom there may be perceived benefits. The existing situation functions in some respects as a telehealth demonstration project, offering information on both clinical and financial efficacy. Evidence that telehealth can reduce costs could lead to its rapid adoption without the proper safeguards, avoiding provider abuse or the exclusion of populations that require regular, in-person medical care. Additional factors at the level of the health system concern telehealth technology training for both patients and clinicians. Patients in particular could require help learning how to utilize new technologies, including how to set them up so that they are accessible to them. A “test run” may help some disabled people reduce the stress brought on by a novel kind of interaction. To ensure the highest level of accessibility, providers who are less experienced need to be given access to training and resources. Systems of health care must provide the appropriate personnel.
Discussion and Conclusion
Globally, access to healthcare services has improved thanks to telehealth, the use of technology to deliver a range of healthcare services over distance. The assessment, diagnosis, and care of patients are all possible with telehealth services. For remote populations or those who cannot readily obtain healthcare services, such as the elderly with chronic conditions and those in geographically remote locations with limited access to specialized and generalist care, telehealth has proven to be especially helpful.
The COVID-19 program used as a “nudge” to encourage and “fast-track” technological innovation and adoption across a variety of industries, including retail and commerce, education, and healthcare. In order to combat the consequences of lockdowns, problems with service delivery, and supply chain challenges, patients and clinicians sought to maintain continuity of care during COVID-19, which led to a significant increase in telehealth delivery globally. For example, many urologists were utilizing telephone consultations and telemedicine prior to COVID 19 for the benefit of patients and clinicians (even only as follow-ups) (Lawrentschuk, 2021). The pandemic has increased the deployment of such instruments out of urgency to keep healthcare systems operating. The doctor-patient relationship still requires trust, and it’s important to never lose sight of “the healing touch or hand” of medicine. This chance, as well as others, may be lost to us due to telehealth. For example, a familiar face with favorable body language may become unfamiliar, and more structured and depersonalized admissions with limited hospital visits cannot be encouraged.
In addition to supporting clinical care, telehealth also assisted with a wider range of duties inside the healthcare system, such as patient education and supply chain management. According to preliminary studies, telemedicine played an important part in the pandemic response, enabling medical delivery through video and voice visits. Unintended consequences, including as equity, literacy, and other concerns, have also been highlighted by evaluation of telehealth service delivery during the pandemic.
Even with their accessible design, telehealth technologies will worsen health disparities for those with disabilities and low socio-economic status if they are not used with sufficient care. Specifically, it is commonly known that people with disabilities have disproportionately reduced access to broadband services, as well as ownership and use of the hardware necessary to access telehealth. A worse standard of care may emerge from missed appointments, disconnections, and misinterpretations caused by a lack of enough bandwidth and modern hardware. Although there are no explicit regulations requiring accessible telehealth services, the US Department of Justice mandates that these telehealth providers must adhere to the same accessibility requirements. The development of precise, detailed, and enforceable standards for digital web accessibility will ensure that accessibility is taken into account in the design stages prior to the use of telehealth technology in a healthcare context, hence accelerating the accessibility of telehealth. There will be variations in the care given to the disability population without rules establishing the standards for digital accessibility.
It is possible to think of telehealth as a particular area of the larger idea of eHealth. eHealth includes all ICT applications that support and connect local and remote players in the health system as well as processes for providing health services. These include specialized applications like teleradiology as well as infrastructure-based solutions like regional health networks, electronic patient record systems, and electronic prescribing. The methods in which telehealth applications may be prioritized and implemented in a given national/regional setting depend significantly on the overarching health system priorities and corresponding eHealth strategy. The supportive function of eHealth in creating integrated models of care is briefly covered in this section.
The current healthcare requires a resilient and sustainable digital health system that can provide effective, efficient, and equitable care under situations like a worldwide pandemic, as demonstrated by the COVID-19 pandemic. With the help of telehealth, a health system can be disrupted and redesigned around the care needs of individuals and populations, giving them the authority to direct the delivery of their own healthcare without being influenced by other, more general health system variables like socioeconomic status. Telehealth as a method of delivering healthcare has grown unexpectedly and unintentionally as a result of the pandemic. In spite of the fact that individuals with disabilities are sometimes ignored when evaluating the diverse effects of health information technology, it is crucial to take into account and be sensitive to their particular constellation of requirements in this new era of pervasive telehealth.
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