Older age, Non-White Race Associated with Poorer Telemedicine Satisfaction.

Shari Lipner, MD, PhD

A recent investigation into disparities in telemedicine practices found that older age and non-White race were associated with poorer telemedicine satisfaction.

Telemedicine use has become more prevalent during the ongoing COVID-19 pandemic. However, there is limited data on patient satisfaction with tele-dermatology,which prompted Shari Lipner, MD, PhD, Associate Professor of Dermatology at Weill Cornell Medicine, and fellow investigators from Weill Cornell Medicine to examine patient experiences at the university’s academic center.

The Methods

After receiving approval by the Weill Cornell Meidicne Institutional Review Boeard, Lipner and colleagues enrolled patients scheduled for tele-dermatology visits between January and April 2021.

Patients were then sent pre- and post-consultation questionnaires about telemedicine satisfaction, expectations, and concerns. Responses were graded on a 5-point Likert scale.

The study received a 82% response rate.

Continuous outcomes were also reported as means and categorical outcomes as percentages, and Fischer’s exact and Chi-squared tests compared responses based on gender, age group, race, and clinic distance, respectively.

From there, identical pre- and post-consultation questions were compared with Wilcoxon signed-rank test (P<0.5).

The Findings

A total of 202 participants were enrolled in the study, 120 (59%) of whom were female with a mean age of 49 years. Participants were predominantly White (78%) and non-Hispanic (86%), and a majority had at least a college degree (94%) and were employed (66%).

When compared to older participants, younger patients (21-40 years old) were more satisfied with telemedicine (P=.016) and its convenience (P=.001).

Additionally, those with shorter travel times of 30 minutes or less preferred in-person visits (P=.031).

Investigators observed that non-White race was associated with greater concerns for conversation privacy and inappropriate information access (P=.004), while White race was associated with greater confidence in telemedicine diagnosis (P=.032).

Overall, the team believed their study demonstrated positive attitudes towards tele-dermatology despite decreases satisfaction and confidence recorded among older and non-White participants.

They also hypothesized that patients with longer clinic proximity would improve access to care in areas without dermatologists.

Regarding privacy concerns among non-White participants, Lipner and colleagues referenced a similar study that utilized semi-structured interviews to survey African-Americans on perceived advantages and disadvantages of telemedicine and found that concerns with confidentiality were prominent.

Additionally, in another cohort study of 148,402 patient scheduled for primary care and subspecialty telemedicine visits, Asian were 31% less likely to use telemedicine and Blacks were 35% less likely to have their videos on compared to White patients.

Though telemedicine had provided access to dermatological care during the pandemic, Lipner and colleagues noted that the management of confidentiality concerns should be considered to encourage equitable telemedicine use.

“Our study clarified specific concerns that may be utilized to devise strategies to encourage universal utilization of tele-dermatology where appropriate,” the team wrote.

The study,"Disparities in Telemedicine Satisfaction Among Older and Non-White Dermatology Patients: A Cross-Sectional Study," was published online in JDD Online.