Primary Care Telehealth Device Use Varies by Age, Race, Income

Allison Hare, MD

The current iterative uses of telehealth among US patients may vary based on age, race, and income, according to new findings.

A cross-sectional analysis of telehealth use among adult Americans in the Penn Medicine health care system suggested that tablets and telephones are the most commonly used tools for remote care visits and consultations—though the rate of use differed among younger versus older patients as well as those from different races and ethnicities.

The new data could implicate the future frontline primary care telehealth strategy, as well as public health-level efforts to expand telehealth availability across differing US populations.

A team led by Allison Hare, MD, and Eric Bressman, MD, MSHP, of the department of medicine at Perelman School of Medicine, conducted a study of telehealth visits held at a Penn Medicine primary care practice during the COVID-19 pandemic. The team sought to interpret the variability of devices used by patients based on demographics, noting that previous research has lacked such context despite an growing emphasis on remote care practice.

“Given the surge in telehealth use during the COVID-19 pandemic, concerns exist about unequal access to telehealth among disadvantaged populations,” they wrote. “Efforts to improve telehealth access may be facilitated by a better understanding of how patients access these visits.”

The team identified adults ≥18 years old who completed ≥1 telehealth visit between December 9, 2020 and September 30, 2021 at the primary care practice. They assessed each observed patient’s self-reported race and ethnicity, as well as zip code-based median household income data based on electronic health records.

A multivariate logistic regression model using generalized estimating equations helped analyze the link between patient demographics and use of telehealth tools such as telephones, tablets, computers or laptops. Hare and Bressman additionally reported odds ratios (ORs) to compare the use of each device based on patient demographics.

The final analysis included 55,812 adult patients who completed ≥1 telehealth visit at the practice. Among them, 41.6% (n = 23,243) used a desktop or laptop for their visit, while 58.4% (n = 32,569) used a phone or tablet.

White patients were significantly less likely than Black patients to use a phone or tablet during their visit (OR, 0.44; 95% CI, 0.36 – 0.52) as were non-Hispanic and non-Latino patients versus Hispanic or Latino patients (OR, 0.73; 95% CI, 0.66 – 0.81).

Investigators additionally observed lesser use of telephones or tablets among adults ≥80 years old versus those 18-29 years old (OR, 0.79; 95% CI, 0.68 – 0.91) as well as among those with a greater median income per zip code, versus lower median income (OR, 0.79; 95% CI, 0.70 – 0.90).

Hare, Bressman and colleagues stressed these observed disparities in telehealth may benefit and tailor strategies around bolstering the availability of telehealth in the US.

“Use of desktops or laptops depends on access to wired broadband, whereas smartphones and many tablets can use either wired or wireless broadband,” they wrote. “Our findings suggest that beyond the recent major federal investment in wired broadband, other opportunities (eg, financial support for cellular data plans, expansion of 5G networks into underserved communities) may help support patients in accessing telehealth services.”

They called on future interventions that may “bridge the digital divide,” such as further analysis into what type of telehealth device is used by which patients.

The study, “Association Between Patient Demographic Characteristics and Devices Used to Access Telehealth Visits in a US Primary Care Network,” was published online in JAMA Health Forum.