Language-Specific Challenges and Solutions for Equitable Telemedicine Implementation in the Primary Care Safety Net During COVID-19.
access to care
health equity
limited English proficiency
safety-net clinics
telemedicine
Journal
Journal of general internal medicine
ISSN: 1525-1497
Titre abrégé: J Gen Intern Med
Pays: United States
ID NLM: 8605834
Informations de publication
Date de publication:
Nov 2023
Nov 2023
Historique:
received:
02
12
2022
accepted:
23
06
2023
pmc-release:
01
11
2024
medline:
27
11
2023
pubmed:
1
9
2023
entrez:
31
8
2023
Statut:
ppublish
Résumé
Telemedicine care dramatically expanded during the COVID-19 pandemic. We characterized facilitators and barriers to telemedicine implementation among safety-net primary care clinics serving patients with limited English proficiency (LEP). We collected data on telemedicine volume and patient demographics among safety-net clinics participating in a telemedicine learning collaborative. Data on various metrics were reported to the collaborative from February 2019 through August 2021. We conducted semi-structured interviews with clinical and quality leaders, purposively sampling clinics serving high proportions of patients with LEP. We analyzed interviews with a mixed inductive-deductive approach applying the Consolidated Framework for Implementation Research. By September 2020, the 23 sites served 121,589 unique patients with in-person and 120,338 with telephone visits; 47% of these patients had LEP. Of 10,897 unique patients served by video visits, 38% had LEP. As a proportion of total visits, telemedicine (telephone and video) visits increased from 0-17% in October 2019-March 2020 to 10-98% in March-August 2020. We conducted 14 interviews at 11 sites. Themes included (1) existing telemedicine platforms and interpreter services were not optimized to support patients with LEP; (2) clinics invested significant labor iterating workflows; (3) sites with technological infrastructure and language-concordant staff were best suited to serve patients; (4) patients speaking less-represented languages or experiencing intersecting literacy barriers were underserved with telemedicine. Interviewees recommended innovations in telemedicine platforms and community-based access. Safety-net sites relied on existing resources to accommodate patients with LEP, but struggled providing access for the most marginalized. Proactive, data-driven strategies to address patient and community barriers as well as optimize clinical workflows with high-quality, certified medical interpreters are needed to ensure equitable access.
Identifiants
pubmed: 37653210
doi: 10.1007/s11606-023-08304-2
pii: 10.1007/s11606-023-08304-2
pmc: PMC10651814
doi:
Types de publication
Journal Article
Langues
eng
Sous-ensembles de citation
IM
Pagination
3123-3133Informations de copyright
© 2023. The Author(s), under exclusive licence to Society of General Internal Medicine.
Références
JAMA. 2019 Oct 22;322(16):1605-1607
pubmed: 31638666
JMIR Med Inform. 2020 Dec 4;8(12):e24544
pubmed: 33191247
JAMA. 2020 Jun 16;323(23):2381-2382
pubmed: 32463421
Health Aff (Millwood). 2016 Aug 1;35(8):1399-403
pubmed: 27503963
BMC Health Serv Res. 2022 Feb 14;22(1):195
pubmed: 35164746
Pediatrics. 2021 Feb;147(2):
pubmed: 33468598
Qual Health Res. 2006 Apr;16(4):547-59
pubmed: 16513996
J Gen Intern Med. 2006 Jul;21(7):786-91
pubmed: 16808783
Implement Sci. 2009 Aug 07;4:50
pubmed: 19664226
Am J Prev Med. 2021 Sep;61(3):434-438
pubmed: 33781622
J Gen Intern Med. 2011 Feb;26(2):170-6
pubmed: 20878497
AMA J Ethics. 2017 Mar 1;19(3):245-252
pubmed: 28323605
JAMA Netw Open. 2020 Jun 1;3(6):e205873
pubmed: 32585018
J Gen Intern Med. 2004 Mar;19(3):221-8
pubmed: 15009776
Health Aff (Millwood). 2022 May;41(5):643-646
pubmed: 35500190
Circulation. 2020 Aug 4;142(5):510-512
pubmed: 32510987
J Gen Intern Med. 2021 Oct;36(10):3071-3079
pubmed: 33987786
JAMIA Open. 2021 Aug 02;4(3):ooab056
pubmed: 34632322
Telemed J E Health. 2022 Aug;28(8):1117-1125
pubmed: 34935517
Circulation. 2021 Sep 21;144(12):913-915
pubmed: 34543062
J Gen Intern Med. 2022 Feb;37(2):472-474
pubmed: 33140275
Med Care. 2021 Nov 1;59(11):1014-1022
pubmed: 34534186
J Gen Intern Med. 2007 Nov;22 Suppl 2:331-5
pubmed: 17957420
NAM Perspect. 2020 Feb 18;2020:
pubmed: 34532683
Health Aff (Millwood). 2021 Mar;40(3):487-495
pubmed: 33646862
JMIR Hum Factors. 2021 Dec 15;8(4):e33364
pubmed: 34705664
JAMA. 2021 Mar 16;325(11):1106-1107
pubmed: 33528494
Med Care. 2015 Nov;53(11):940-7
pubmed: 26465121
J Am Board Fam Med. 2022 May-Jun;35(3):588-592
pubmed: 35641044
Int J Qual Health Care. 2007 Dec;19(6):349-57
pubmed: 17872937
JAMA Netw Open. 2020 Apr 1;3(4):e203028
pubmed: 32301990
J Am Board Fam Med. 2020 Nov-Dec;33(6):953-968
pubmed: 33219074
Am J Manag Care. 2021 Mar;27(3):93-95
pubmed: 33720665
Health Serv Res. 2007 Apr;42(2):727-54
pubmed: 17362215
Ann Fam Med. 2022 Jul-Aug;20(4):362-367
pubmed: 35879077
SSM Qual Res Health. 2022 Dec;2:100054
pubmed: 35169769
JAMA Netw Open. 2020 Dec 1;3(12):e2031640
pubmed: 33372974
Implement Sci. 2013 May 10;8:51
pubmed: 23663819
Am J Manag Care. 2021 Jan;27(1):21-26
pubmed: 33471458
Jt Comm J Qual Patient Saf. 2011 Oct;37(10):437-45
pubmed: 22013816
JAMA Netw Open. 2021 Nov 1;4(11):e2133129
pubmed: 34735015
Health Aff (Millwood). 2018 Dec;37(12):2060-2068
pubmed: 30633679
Am J Public Health. 2000 Aug;90(8):1212-5
pubmed: 10936998
Med Care. 2020 Jan;58(1):45-51
pubmed: 31821245
J Am Board Fam Med. 2021 Nov-Dec;34(6):1103-1114
pubmed: 34772766