Clinicians are taking on the onus of bridging the digital divide, survey finds

A February Health Affairs study found that within the chasm referred to as “the digital divide,” providers are finding their own ways to improve digital equity.

By assessing a longitudinal survey of clinicians treating patients with opioid use disorder (OUD), the study found that while telemedicine is down from its peak in 2020, clinicians are still actively fighting digital redlining. Researchers from the RAND Corporation and Harvard University found that 77% of clinicians in March 2022 implemented digital equity strategies to help patients overcome barriers to video visits.

“One of the key questions that this research brings up is whose responsibility is it to support patients in navigating the complexity of bridging the digital divide? We ask a lot of clinicians,” Lori Uscher-Pines, senior policy researcher at the RAND Corporation, told Fierce Healthcare. “It may be that some of these strategies should be the shared responsibility of payers or community groups or other entities in the community.”

Strategies clinicians reported utilizing to bridge the gap include providing educational materials, offering technical assistance, hosting patients in clinics or parking lots where they can access Wi-Fi connectivity and even providing personal devices.

Overall, group clinical practices were more likely to provide support to patients struggling to connect. Solo clinical practices were nearly half as likely to commit to the expensive task of providing personal devices to patients who lack them.

Of populations living in affluent, urban areas, 97% of patients have access to reliable broadband while 65% of people in rural areas have access, a Pew Research study found. Patients living in low-income zip codes are also more likely to use audio-only technology to communicate with healthcare providers. 

The most common practice used by healthcare providers to decrease telehealth friction points was sharing educational materials, a deceptively Herculean task, Uscher-Pines said. For solo practices, 20% offered this service, while that number increases to 43% for group practices.

“If you're serving patients in multiple languages, you may need to make these resources translated into all the languages of the patients that you serve,” she said. “And it's not enough to just have an interpreter on the line when you do telemedicine, you also need to have all of the communication about that visit and the technical support available in a large number of languages.”

The study surveyed 602 clinicians who provide medication treatment for OUD. One of the requirements for recruitment was that the clinician held a current buprenorphine prescribing waiver.

Previous research has found that patients being treated for OUD and low-income patients had higher use of audio-only visits. However, the surveyed clinicians showed a preference for video-enabled visits.

Only 31.5% of respondents reported that audio-only visits were as effective as in-person care, thereby indicating a strong impetus for fostering the use of more advanced modalities in treatment.

From December 2020 to March 2022, results showed that telemedicine use declined from 56.7% of all OUD visits to 41.5%. Audio-only visits saw a similar decrease from 35.6% to 28% for all telemedicine visits for OUD.

Researchers found that high audio-only telemedicine use was not associated with clinician type, primary practice setting or patient insurance. When asked in March 2022 what percentage of OUD visits would physicians prefer to conduct audio-only appointments with, 63% said they would prefer to have no audio-only appointments.

“One main reason why you're still seeing so much audio-only visit utilization at this stage in the pandemic is it's easier for clinicians to deliver audio only because there's less friction and fewer technical problems that arise,” Uscher-Pines said. “We're almost three years in and there's still high levels of use of audio-only visits included in this sample and elsewhere in the healthcare system.”

Uscher-Pines thinks that when it comes to vulnerable populations and safety net settings, there may be continued significant use of audio-only visits, “because of the barriers that exist to do video visits.”

One barrier to telephonic care was knocked down with the recent Omnibus Bill, which allows for the continued use of the modality after the end of the COVID-19 public health emergency.

Pandemic waivers allowed for the widespread use of new technologies to treat OUD and prescribe medications for opioid use disorder (MOUDs) like buprenorphine. Although the continued prescribing of MOUDs without at least one in-person visit may be in jeopardy following the recent announcement of the May 11 winding down of the public health emergency.

Looking further into the gaps in telehealth access, Uscher-Pines sees unique promise in the employment of digital navigators. This support system, she said, can walk patients through how to use a platform or how to download the right software to gain access to digital care. “It would be great to see more research on the effectiveness of that and how best to support those types of programs.”