The influence of teledermatology on health care access and equity
Authors: Edward Hadeler, Jacob Beer, Keyvan Nouri
Journal: Journal of the American Academy of Dermatology (2021)

To the Editor: We commend the article, Understanding the Impact of Teledermatology on No-Show Rates and Healthcare Accessibility: A Retrospective Chart Review, in discussing telemedicine's influence on health access during the COVID-19 pandemic.1Franciosi E.B. Tan A.J. Kassamali B. O'Connor D.M. Rashighi M. LaChance A. Understanding the impact of teledermatology on no-show rates and healthcare accessibility: a retrospective chart review.J Am Acad Dermatol. 2021; 84: 769-771Abstract Full Text Full Text PDF PubMed Scopus (26) Google Scholar The study retrospectively compared no-show rates for in-person and televisit appointments at UMass Memorial Hahnemann Campus during 2019 and 2020. Categorizing these results by demographic factors that included race and ethnicity, the authors inferred that no-show rates decreased among minority patients, and that a significantly higher proportion of Medicaid patients used telehealth over in-person services.2Syed S.T. Gerber B.S. Sharp L.K. Traveling towards disease: transportation barriers to health care access.J Community Health. 2013; 38: 976-993Crossref PubMed Scopus (1017) Google Scholar Here we provide additional context. We agree with the authors that telemedicine may benefit attendance rates for urban communities. Additionally, our review of national data suggests that failure to offer telemedicine to rural communities and lower socioeconomic individuals could contribute to their low usage. Despite a recent resurgence, telemedicine's history spans decades; remote medical practice showed promise for extending care to patients of lower socioeconomic status or in geographically isolated areas. However, data published in the 2011 Census Bureau's Computer and Internet Use Supplement of the Current Population Survey3Exploring the Digital Nation: America's Online Experience.https://www.ntia.doc.gov/files/ntia/publications/exploring_the_digital_nation_-_americas_emerging_online_experience.pdfDate accessed: September 27, 2020Google Scholar showed that these and other demographics were least likely to use telemedicine. The Census data included responses from over 53,000 US households and found the individuals who used telemedicine least (1) had low income (<$25,000), (2) were older than 65, (3) had no high school diploma, or (4) lived in rural areas. The responses also uncovered comparatively low internet access rates among Black and Hispanic respondents. Researchers duplicated these findings.4Park J. Erikson C. Han X. Iyer P. Are state telehealth policies associated with the use of telehealth services among underserved populations?.Health Aff. 2018; 37: 2060-2068Crossref Scopus (109) Google Scholar From 2013 to 2016, the Association of American Medical Colleges commissioned a survey of telehealth usage, collecting more than 22,000 responses. Using that data, researchers at George Washington found that Medicaid beneficiaries and low-income and rural populations were among the least likely populations to use telemedicine. Another survey by the American Telemedicine Association in 2016 found the most frequently cited barrier to using telehealth was lack of offerings by providers; only 38% of surveyed community health centers offered telemedicine.4Park J. Erikson C. Han X. Iyer P. Are state telehealth policies associated with the use of telehealth services among underserved populations?.Health Aff. 2018; 37: 2060-2068Crossref Scopus (109) Google Scholar It is a limitation in our review that these surveys encompassed telemedicine generally, not teledermatology specifically. Further population studies are needed to evaluate national scale teledermatology use. Nonetheless, the UMass study adds possible insights. The year 2020 corresponded with a significant increase in televisit attendance at UMass, particularly among Blacks or African-Americans, LatinX, and patients whose primary language was not English. In contrast to data from the Census and Washington University's study, which indicated low overall use of telehealth services by Medicaid enrollees, Franciosi et al1Franciosi E.B. Tan A.J. Kassamali B. O'Connor D.M. Rashighi M. LaChance A. Understanding the impact of teledermatology on no-show rates and healthcare accessibility: a retrospective chart review.J Am Acad Dermatol. 2021; 84: 769-771Abstract Full Text Full Text PDF PubMed Scopus (26) Google Scholar found transitioning to telehealth increased the percentage of Medicaid enrollees served at their clinic. Therefore, the UMass study may demonstrate that Medicaid patients are, in fact, likely to accept telehealth when offered. The degree to which telemedicine improves access to medical services varies among communities. Patients of lower socioeconomic status within urban communities, like at UMass, may benefit most. We encourage the academic community to explore where else to expand telemedicine, particularly by assessing changes in no-show rates at academic institutions and community medical centers serving rural communities. None disclosed. Understanding the impact of teledermatology on no-show rates and health care accessibility: A retrospective chart reviewJournal of the American Academy of DermatologyVol. 84Issue 3PreviewAt the onset of the COVID-19 pandemic, emergency legislation expanding the coverage of telehealth service swept across the nation to allow for continued access to medical care despite strict shelter-in-place guidelines.1 In the wake of this, telehealth usage has increased dramatically.2 Dermatology, in particular, is uniquely amenable to virtual visits, and teledermatology has the potential to become a permanent platform from which we provide specialty care. Full-Text PDF Response to the influence of teledermatology on health care access and equityJournal of the American Academy of DermatologyVol. 84Issue 4PreviewWe thank Hadeler and his co-authors for their support of our research and for providing additional context regarding telemedicine's impact on health care access and equity.1 Although we found that teledermatology services performed during the COVID-19 pandemic benefitted minority and Medicaid patients, Hadeler et al highlight previous survey-based studies from 2011 and 2013 to 2016 that demonstrated these patients were the least likely to utilize telemedicine.2 We believe there are 2 key factors that likely contributed to the increased appointment attendance among minority and Medicaid patients found in our study reflecting the rapidly evolving landscape of telemedicine. Full-Text PDF