While society has made changes to accommodate the need for physical distancing to slow the spread of COVID-19, such as grocery deliveries, working from home and even drive-thru voting, the healthcare field is doing the same by providing care to patients through telehealth when possible. However, as experts from Baylor College of Medicine have found, there are disparities when it comes to access to the internet among those who are suffering from chronic health conditions such as hypertension and diabetes.
The findings are in the current edition of Diabetes Care.
"Some patients may be avoiding the doctor's office for follow-up visits due to fear of exposure to the virus, so chronic diseases may actually worsen," said Dr. Salim Virani, professor of medicine-cardiology at Baylor and a cardiologist with the Michael E. DeBakey Veterans Affairs Medical Center. "Telehealth can be a valuable solution."
Telehealth is the ability for a patient to talk to and see a doctor via the internet, but not everyone has access to an internet connection. Virani and his team wanted to address disparities in internet access among those with hypertension or diabetes versus those without. They also wanted to understand what role race played in these disparities.
They reviewed data from the 2016-17 Behavioral Risk Factor Surveillance System, a nationwide telephone-based questionnaire from the CDC that collects data on health-related behaviors, health conditions and use of preventative services.
They identified 910,655 participants and studied the association between hypertension, diabetes, race and internet use, which was based on the question, "Have you used the internet in the past 30 days?"
The prevalence of internet use was 74 percent among those with hypertension compared with 89 percent among those without, and 65 percent among those with diabetes compared to 86 percent without. When it came to race, they found that, in general, Blacks and Hispanics with hypertension or diabetes had a much lower prevalence of internet use compared to whites. For example, Blacks and Hispanics with hypertension or diabetes had 51 percent and 42 percent lower odds, respectively, of internet use compared to whites with hypertension or diabetes. This disparity varied widely across the United States. Overall, researchers found that frequent internet users were more likely to be white, educated, employed, younger or having healthcare coverage.
The data did not take into account the quality of internet connection or whether the internet was accessed at work, home, public library or via smartphone. These factors also could impact the quality of telehealth care.
"Being able to identify these disparities is important from a public health policy standpoint to ensure that all patients receive equitable healthcare," Virani said. "Efforts are needed to mitigate these disparities, especially since Black and Hispanic populations have higher rates of hypertension and diabetes. Given that morbidity and mortality from COVID-19 is much higher in patients with diabetes or hypertension, and that these patients require chronic care that is now delivered using telehealth, efforts are urgently needed to ensure that the racial and ethnic disparities in outcomes seen in COVID-19 do not spill over into chronic disease care as we shift to a telehealth model of care delivery."
Others who took part in the study include Drs. Mahmoud Al Rifai, Michelle T. Lee, Laura A. Petersen, Elizabeth M. Vaughan, Christie M. Ballantyne, all with Baylor and/or the Michael E.DeBakey Veterans Affairs Medical Center Health Services Research and Development Center for Innovations in Quality, Effectiveness and Safety (IQuEST), Ankur Kalra and Vardhmaan Jain, both with the Cleveland Clinic, and Nathan D. Wong, University of California, Irvine.
For funding for the study, Virani reports receiving research funding from the Department of Veterans Affairs, World Heart Federation and the Tahir and Jooma Family. He has received honorarium from the American College of Cardiology in his role as the Associate Editor for Innovations.
