How Does the Digital Divide in the US Compromise Healthcare?

John Whyte, MD, MPH; Lisa Fitzpatrick, MD, MPH, MPA

Disclosures

June 10, 2020

Find the latest COVID-19 news and guidance in Medscape's Coronavirus Resource Center.

  • Patients with low health literacy may not understand or pay attention to the health messages provided by healthcare professionals.

  • Telemedicine can provide access to healthcare in underserved communities. Not all individuals in these communities have adequate access to broadband internet, however, which is required for a video telemedicine visit.

  • Distrust in technology in underserved urban and rural communities poses a challenge in providing telemedicine.

  • It is a misperception that older people don't readily use or adopt technology.

  • Telemedicine is not going to bridge all of the health divides and address the disparities, but it can serve as an adjunct in reaching out to people in certain communities.

This transcript has been edited for clarity.

John Whyte, MD, MPH: You're watching Coronavirus in Context. I'm Dr John Whyte, chief medical officer at WebMD. With everyone staying at home using the internet, we often forget that there still exists a digital divide, people who don't have access to broadband, to the internet. How does that compromise their health? To help answer that question, I've asked Dr Lisa Fitzpatrick, a physician and epidemiologist, to join me. Dr Fitzpatrick, thanks for joining me today.

Lisa Fitzpatrick, MD, MPH, MPA: Hello. Thank you for having me.

Whyte: You have this great thing that you do where you go on the street—it's called "Dr Lisa on the Street"—where you're trying to communicate about health topics. Tell me why.

Fitzpatrick: I do that for a few reasons, foremost because my patients don't understand their bodies. They don't understand how to talk to doctors. And most of the time, they don't understand what we're saying to them.

I learned this the hard way because many years ago, probably dating back to 2008, I saw a woman who was referred to me for HIV, but she also had heart disease and high cholesterol. I was talking to her about her diet, and she said, "No one ever told me that the things I eat would increase my cholesterol."

I couldn't believe that. So from that point on, I started to quiz patients about what they understood about all the health information that had been communicated to them up to that point when they saw me. I was humbled by the low health literacy, and I really wanted to do something about it.

I realized that people aren't really paying attention to the information on the internet, the pamphlets that we make for them. And I wanted to find a more effective way to really hear from people and try to engage them in health information.

Whyte: We've been talking a lot about telehealth during this pandemic and how it's helping people who may not typically have access. Let's start with the positive. How is telehealth, telemedicine, improving health in underserved communities?

Fitzpatrick: This is a great question, and I appreciate you covering this topic. We submitted a survey at the beginning of the stay-home measure here in Washington, DC, and asked people if they had access to telemedicine. We've only had about 75 responses so far, mostly because we sent those out through Facebook channels and through some of our community partners, and didn't expect the uptick to be that great.

But what we've learned is that 75% of those people had access to a doctor's visit, whether it was a phone call or a video visit. The video visits can become a bit more challenging because we also study what kind of services people have on their phones.

And although cellphone ownership is ubiquitous, not everyone has access to at least a 4G network that has the strength and capacity to conduct a video visit. So I think there's definitely a disparity there. But people are open to video visits and televisits.

Whyte: I want to read you a statistic I found in a 2020 broadband study that said 42 million Americans do not have adequate access to broadband. How does that impact particular communities?

Fitzpatrick: Particularly in communities where you don't have the volume of providers or access to providers, particularly specialists, such as heart specialists or kidney specialists, this provides an access issue that creates and exacerbates disparities. [This happens in] rural areas also, where you don't have access to providers, and in some cases, even primary care.

I think the challenge is that if we don't have access to telehealth or telemedicine, the technology so that people can access care, we're going to see an increase in these disparities because people either give up or they think it's too hard to access a doctor. And the longer people delay care, the sicker they become and the more costly [they are to] the healthcare system.

Whyte: All right, so take out your magic wand. How do you fix it?

Fitzpatrick: I believe that the internet should be a public utility. With the expanding access to Wi-Fi in a lot of communities, particularly in urban areas, we are seeing increasing access to telemedicine for underserved populations. But I also think we have to educate the community about telemedicine.

Whyte: Remember that cities were going to make free access to Wi-Fi? That didn't go as well as places wanted it to.

Fitzpatrick: Right. It has to be coupled with education about the service. But also, remember that there is a lot of distrust in a lot of our underserved communities and even some of our rural areas. A perfect example is that during this pandemic, I heard many people talk about 5G exacerbating coronavirus infection or helping to spread coronavirus infection.

With that kind of misinformation about technology and distrust of technology, we really need to educate people and build trust to get them to use, or at least try to use, these tools. If the messengers are trusted messengers, we can increase access and uptake of telemedicine tools in underserved communities.

Whyte: Let's talk about the generational divide. The young kids are always on their phones and tablets. I don't even have the tech savviness that some of them do. Let's compare that to an elderly population, where the perception is that they don't have the ability to use some of the services because they do not have as much experience with smartphones. Do you think that's true? Has that changed?

Fitzpatrick: I think it's changing a lot. There are some misperceptions around usage and access, to the ability to use these tech tools among the elderly, or among people over the age of 60 or 65. Case in point: During the pandemic, I have been meeting via Zoom with a senior center here in Southeast [DC].

These seniors have been prepared. They've been very engaged to do all sorts of things by Zoom. Last week, they told me, "Dr Fitzpatrick, we've been going around the world! We've been to all of these countries, and it's all been on the internet."

Older people are also connecting to the internet because it keeps them connected to their families, particularly their grandchildren. We haven't paid attention to understand how much this has penetrated the elderly population.

My mother, who's 75 years old, lives in a retirement community. She served as a computer monitor, teaching her fellow residents how to use the computer. So it's not as bad as we think.

Whyte: Some of it is education and some of it is about getting people used to it. But what do we do in those communities that don't have access? How do we fix it there?

Fitzpatrick: This is a great question, too, because I think telemedicine, as much as we'd like it to, is not going to bridge all of the health divides we're seeing nor address the disparities we're seeing. People still need to trust in the healthcare system. They still need to trust their healthcare providers.

When we're out on the street, even during the pandemic, it's become painfully clear that the response needs to be out in the community where people are. I think telemedicine can serve as an adjunct to reaching out to people. There needs to be the human element enabled or bolstered by the tech tool.

Tech is not the panacea or the answer. I started Grapevine Health because I know that there is a missed opportunity to reach underserved populations using technology, particularly related to health literacy and engagement in healthcare.

Whyte: Where can viewers find more information about what you're doing?

Fitzpatrick: People can find us on our website at grapevinehealth.co. We're on all the social media channels: Instagram and Facebook at Grapevine Health and on Twitter @HealthGrapevine.

Whyte: Terrific. Dr Fitzpatrick, I want to thank you for taking time to speak with us today.

Fitzpatrick: Thank you very much.

Whyte: And I want to thank you for watching Coronavirus in Context. I'm Dr John Whyte.

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