Telehealth Use By Persons with Disabilities During the COVID-19 Pandemic

  • Carli Friedman CQL | The Council on Quality and Leadership
  • Laura VanPuymbrouck Rush University
Keywords: COVID-19 pandemic, Persons with disabilities, Telehealth

Abstract

Telehealth use rapidly expanded during the COVID-19 pandemic. Understanding if, and how, people from disabilities used telehealth during the pandemic is vital to assuring this evolving and increasingly common form of health care is equitably developed and delivered to avoid reproducing the health disparities people with disabilities already face. Our aim was to explore the use of telehealth among people with disabilities during the pandemic. We conducted a weighted secondary analysis of United States Census Bureau data (April-July 2021) from 38,512 (unweighted) people with disabilities. Our findings revealed 39.8% of people with disabilities used telehealth during the second year of the pandemic, ranging from 34.5% of people with hearing disabilities to 43.3% of people with mobility disabilities. There were also differences in telehealth use based on sociodemographics. Telehealth promises to open doors to more equitable health care access for many people with disabilities, but only if access barriers are removed.

  

References

Anderson, M., & Perrin, A. (2021, September 10). Americans with disabilities less likely than those without to own some digital devices. Pew Research Center. https://www.pewresearch.org/fact-tank/2021/09/10/americans-with-disabilities-less-likely-than-those-without-to-own-some-digital-devices/

Annaswamy, T. M., Verduzco-Gutierrez, M., & Frieden, L. (2020). Telemedicine barriers and challenges for persons with disabilities: COVID-19 and beyond. Disability and Health Journal, 13(4), 100973. https://doi.org/10.1016/j.dhjo.2020.100973

Bauerly, B. C., McCord, R. F., Hulkower, R., & Pepin, D. (2019). Broadband access as a public health issue: the role of law in expanding broadband access and connecting underserved communities for better health outcomes. The Journal of Law, Medicine & Ethics, 47(2_suppl), 39-42. https://doi.org/10.1177/1073110519857314

Ben-Zeev, D., Brenner, C. J., Begale, M., Duffecy, J., Mohr, D. C., & Mueser, K. T. (2014). Feasibility, acceptability, and preliminary efficacy of a smartphone intervention for schizophrenia. Schizophrenia Bulletin, 40(6), 1244-1253. https://doi.org/10.1093/schbul/sbu033

Bernard, K., Hasegawa, K., Sullivan, A., & Camargo, C. (2017). A profile of Indian Health Service emergency departments. Annals of Emergency Medicine, 69(6), 705-710. e704. https://doi.org/10.1016/j.annemergmed.2016.11.031

Bonanad, C., García-Blas, S., Tarazona-Santabalbina, F., Sanchis, J., Bertomeu-González, V., Fácila, L., Ariza, A., Núñez, J., & Cordero, A. (2020). The effect of age on mortality in patients with COVID-19: a meta-analysis with 611,583 subjects. Journal of the American Medical Directors Association, 21(7), 915-918. https://doi.org/10.1016/j.jamda.2020.05.045

Bove, R., Garcha, P., Bevan, C. J., Crabtree-Hartman, E., Green, A. J., & Gelfand, J. M. (2018). Clinic to in-home telemedicine reduces barriers to care for patients with MS or other neuroimmunologic conditions. Neurology-Neuroimmunology Neuroinflammation, 5(6). https://doi.org/10.1212/NXI.0000000000000505

Bradley, V. J. (2020). How COVID-19 may change the world of services to people with intellectual and developmental disabilities. Intellectual and Developmental Disabilities, 58(5), 355-360. https://doi.org/10.1352/1934-9556-58.5.355

Brucker, D. L., & Houtenville, A. J. (2015). People with disabilities in the United States. Archives of Physical Medicine and Rehabilitation, 96(5), 771-774. https://doi.org/10.1016/j.apmr.2015.02.024

Centers for Disease Control and Prevention. (2013). The state of aging and health in America 2013. https://www.cdc.gov/aging/pdf/state-aging-health-in-america-2013.pdf

Centers for Disease Control and Prevention. (2019). Disability impacts all of us. https://www.cdc.gov/ncbddd/disabilityandhealth/infographic‐disability‐impacts‐all.html

Centers for Disease Control and Prevention. (2020). Using telehealth to expand access to essential health services during the COVID-19 pandemic. https://www.cdc.gov/coronavirus/2019-ncov/hcp/telehealth.html#print

Centers for Disease Control and Prevention. (2021a). COVID-19: People with certain medical conditions. https://www.cdc.gov/coronavirus/2019-ncov/need-extra-precautions/people-with-medical-conditions.html

Centers for Disease Control and Prevention. (2021b). COVID-19: People with disabilities. https://www.cdc.gov/coronavirus/2019-ncov/need-extra-precautions/people-with-disabilities.html

Centers for Medicare and Medicaid. (2020a). Medicare and Medicaid programs; Policy and regulatory revisions in response to the COVID–19 public health emergency (CMS–1744–IFC). https://www.govinfo.gov/content/pkg/FR-2020-04-06/pdf/2020-06990.pdf

Centers for Medicare and Medicaid. (2020b). Medicare telemedicine health care provider fact sheet. https://www.cms.gov/newsroom/fact-sheets/medicare-telemedicine-health-care-provider-fact-sheet

Chakraborty, J. (2021). Social inequities in the distribution of COVID-19: An intra-categorical analysis of people with disabilities in the US. Disability and Health Journal, 14(1), 101007. https://doi.org/10.1016/j.dhjo.2020.101007

Cochran, A. L. (2020). Impacts of COVID-19 on access to transportation for persons with disabilities. Transportation Research Interdisciplinary Perspectives, 8, 100263. https://doi.org/10.1016/j.trip.2020.100263

Crotty, M., Killington, M., van den Berg, M., Morris, C., Taylor, A., & Carati, C. (2014). Telerehabilitation for older people using off-the-shelf applications: Acceptability and feasibility. Journal of telemedicine and telecare, 20(7), 370-376. https://doi.org/10.1177/1357633X14552382

Darkins, A., Ryan, P., Kobb, R., Foster, L., Edmonson, E., Wakefield, B., & Lancaster, A. E. (2008). Care coordination/home telehealth: The systematic implementation of health informatics, home telehealth, and disease management to support the care of veteran patients with chronic conditions. Telemedicine and e-Health, 14(10), 1118-1126. https://doi.org/10.1089/tmj.2008.0021

de Vries McClintock, H. F., Barg, F. K., Katz, S. P., Stineman, M. G., Krueger, A., Colletti, P. M., Boellstorff, T., & Bogner, H. R. (2016). Health care experiences and perceptions among people with and without disabilities. Disability and Health Journal, 9(1), 74-82. https://doi.org/10.1016/j.dhjo.2015.08.007

Dinesen, B., Nonnecke, B., Lindeman, D., Toft, E., Kidholm, K., Jethwani, K., Young, H. M., Spindler, H., Oestergaard, C. U., & Southard, J. A. (2016). Personalized telehealth in the future: A global research agenda. Journal of Medical Internet Research, 18(3), e5257. https://doi.org/10.2196/jmir.5257

Dobransky, K., & Hargittai, E. (2016). Unrealized potential: Exploring the digital disability divide. Poetics, 58, 18-28. https://doi.org/10.1016/j.poetic.2016.08.003

Dobransky, K., & Hargittai, E. (2020). People with disabilities during COVID-19. Contexts, 19(4), 46-49. https://doi.org/10.1177/1536504220977935

Drainoni, M.-L., Lee-Hood, E., Tobias, C., Bachman, S. S., Andrew, J., & Maisels, L. (2006). Cross-disability experiences of barriers to health-care access: Consumer perspectives. Journal of Disability Policy Studies, 17(2), 101-115. https://doi.org/10.1177/10442073060170020101

Drum, C. E., Krahn, G., Culley, C., & Hammond, L. (2005). Recognizing and responding to the health disparities of people with disabilities. Californian Journal of Health Promotion, 3(3), 29-42. https://doi.org/10.32398/cjhp.v3i3.647

Embregts, P. J., van den Bogaard, K. J., Frielink, N., Voermans, M. A., Thalen, M., & Jahoda, A. (2020). A thematic analysis into the experiences of people with a mild intellectual disability during the COVID-19 lockdown period. International Journal of Developmental Disabilities, Advanced online publication, 1-5. https://doi.org/10.1080/20473869.2020.1827214

FAIR Health, West Health Institute, & Makary, M. (2020). Risk factors for COVID-19 mortality among privately insured patients. FAIR Health. https://www.fairhealth.org/publications/whitepapers

Ferguson, J. M., Jacobs, J., Yefimova, M., Greene, L., Heyworth, L., & Zulman, D. M. (2021). Virtual care expansion in the Veterans Health Administration during the COVID-19 pandemic: Clinical services and patient characteristics associated with utilization. Journal of the American Medical Informatics Association, 28(3), 453-462. https://doi.org/10.1093/jamia/ocaa284

Fischer, S. H., Ray, K. N., Mehrotra, A., Bloom, E. L., & Uscher-Pines, L. (2020). Prevalence and characteristics of telehealth utilization in the United States. JAMA Network Open, 3(10), e2022302-e2022302. https://doi.org/10.1001/jamanetworkopen.2020.22302

Galewitz, P. (2020). Telemedicine surges, fueled by coronavirus fears and shift in payment rules. Kaiser Health News. https://khn.org/news/telemedicine-surges-fueled-by-coronavirus-fears-and-shift-in-payment-rules/

Graves, J. M., Mackelprang, J. L., & Abshire, D. A. (2020). Barriers to telemedicine implementation in Southwest Tribal communities during COVID-19. The Journal of Rural Health, 37(1), 239-241. https://doi.org/10.1111/jrh.12479

Hwang, K., Johnston, M., Tulsky, D., Wood, K., Dyson-Hudson, T., & Komaroff, E. (2009). Access and coordination of health care service for people with disabilities. Journal of Disability Policy Studies, 20(1), 28-34. https://doi.org/10.1177/1044207308315564

Iezzoni, L. (2011). Eliminating health and health care disparities among the growing population of people with disabilities. Health Affairs, 30(10), 1947-1954. https://doi.org/10.1377/hlthaff.2011.0613

Iezzoni, L. I., Rao, S. R., Ressalam, J., Bolcic-Jankovic, D., Agaronnik, N. D., Donelan, K., Lagu, T., & Campbell, E. G. (2021). Physicians’ perceptions of people with disability and their health care: Study reports the results of a survey of physicians' perceptions of people with disability. Health Affairs, 40(2), 297-306. https://doi.org/10.1377/hlthaff.2020.01452

Jesus, T. S., Bhattacharjya, S., Papadimitriou, C., Bogdanova, Y., Bentley, J., Arango-Lasprilla, J. C., Kamalakannan, S., & The Refugee Empowerment Task Force International Networking Group of the American Congress of Rehabilitation Medicine. (2021). Lockdown-Related disparities experienced by people with disabilities during the first wave of the COVID-19 pandemic: Scoping review with thematic analysis. International Journal of Environmental Research and Public Health, 18(12), 6178. https://doi.org/10.3390/ijerph18126178

Khanijahani, A. (2021). Racial, ethnic, and socioeconomic disparities in confirmed COVID-19 cases and deaths in the United States: A county-level analysis as of November 2020. Ethnicity & Health, 26(1), 22-35. https://doi.org/10.1080/13557858.2020.1853067

Kim, H. W., Shin, D. W., Yeob, K. E., Cho, I. Y., Kim, S. Y., Park, S. M., Park, J. H., Park, J. H., & Kawachi, I. (2020). Disparities in the diagnosis and treatment of gastric cancer in relation to disabilities. Clinical and Translational Gastroenterology, 11(10). https://doi.org/10.14309/ctg.0000000000000242

Kim, K. (2021). Impacts of COVID-19 on transportation: Summary and synthesis of interdisciplinary research. Transportation Research Interdisciplinary Perspectives, 9, 100305. https://doi.org/10.1016/j.trip.2021.100305

Krahn, G. L., Walker, D. K., & Correa-De-Araujo, R. (2015). Persons with disabilities as an unrecognized health disparity population. American Journal of Public Health, 105(S2), S198-S206. https://doi.org/10.2105/AJPH.2014.302182

Krysta, K., Romańczyk, M., Diefenbacher, A., & Krzystanek, M. (2021). Telemedicine treatment and care for patients with intellectual disability. International Journal of Environmental Research and Public Health, 18(4), 1746. https://doi.org/10.3390/ijerph18041746

Lazar, J., & Jaeger, P. (2011). Reducing barriers to online access for people with disabilities. Issues in Science and Technology, 27(2), 69-82.

McCarthy, E. P., Ngo, L. H., Roetzheim, R. G., Chirikos, T. N., Li, D., Drews, R. E., & Iezzoni, L. I. (2006). Disparities in breast cancer treatment and survival for women with disabilities. Annals of Internal Medicine, 145(9), 637-645. https://doi.org/10.7326/0003-4819-145-9-200611070-00005

Miu, A. S., Vo, H. T., Palka, J. M., Glowacki, C. R., & Robinson, R. J. (2020). Teletherapy with serious mental illness populations during COVID-19: telehealth conversion and engagement. Counselling Psychology Quarterly, 1-18. https://doi.org/10.1080/09515070.2020.1791800

Mudrick, N. R., Breslin, M. L., Liang, M., & Yee, S. (2012). Physical accessibility in primary health care settings: results from California on-site reviews. Disability and Health Journal, 5(3), 159-167. https://doi.org/10.1016/j.dhjo.2012.02.002

Naslund, J. A., Marsch, L. A., McHugo, G. J., & Bartels, S. J. (2015). Emerging mHealth and eHealth interventions for serious mental illness: A review of the literature. Journal of Mental Health, 24(5), 321-332. https://doi.org/10.3109/09638237.2015.1019054

Nouri, S., Khoong, E. C., Lyles, C. R., & Karliner, L. (2020). Addressing equity in telemedicine for chronic disease management during the Covid-19 pandemic. NEJM Catalyst Innovations in Care Delivery, 1(3). https://doi.org/10.1056/CAT.20.0123

Powers, G. M., Frieden, L., & Nguyen, V. (2017). Telemedicine: access to health care for people with disabilities. Houston Journal of Health Law & Policy, 17, 7-20.

Reichard, A., Stolzle, H., & Fox, M. H. (2011). Health disparities among adults with physical disabilities or cognitive limitations compared to individuals with no disabilities in the United States. Disability and Health Journal, 4(2), 59-67. https://doi.org/10.1016/j.dhjo.2010.05.003

Robb, J. F., Hyland, M. H., & Goodman, A. D. (2019). Comparison of telemedicine versus in-person visits for persons with multiple sclerosis: A randomized crossover study of feasibility, cost, and satisfaction. Multiple Sclerosis and Related Disorders, 36, 101258. https://doi.org/10.1016/j.msard.2019.05.001

Sechrist, S., Lavoie, S., Khong, C.-M., Dirlikov, B., & Shem, K. (2018). Telemedicine using an iPad in the spinal cord injury population: A utility and patient satisfaction study. Spinal Cord Series and Cases, 4(1), 1-8. https://doi.org/10.1038/s41394-018-0105-4

Sekhon, H., Sekhon, K., Launay, C., Afililo, M., Innocente, N., Vahia, I., Rej, S., & Beauchet, O. (2020). Telemedicine and the rural dementia population: A systematic review. Maturitas, 143, 105-114. https://doi.org/10.1016/j.maturitas.2020.09.001

Slightam, C., Gregory, A. J., Hu, J., Jacobs, J., Gurmessa, T., Kimerling, R., Blonigen, D., & Zulman, D. M. (2020). Patient perceptions of video visits using veterans affairs telehealth tablets: survey study. Journal of Medical Internet Research, 22(4), e15682. https://doi.org/10.2196/15682

Triana, A. J., Gusdorf, R. E., Shah, K. P., & Horst, S. N. (2020). Technology literacy as a barrier to telehealth during COVID-19. Telemedicine and e-Health, 26(9), 1118-1119. https://doi.org/10.1089/tmj.2020.0155

Turk, M. A., Landes, S. D., Formica, M. K., & Goss, K. D. (2020). Intellectual and developmental disability and COVID-19 case-fatality trends: TriNetX analysis. Disability and health journal, 13(3), 100942. https://doi.org/10.1016/j.dhjo.2020.100942

United States Census Bureau. (2017). Measuring disability in a census. https://www.census.gov/content/dam/Census/library/working-papers/2017/demo/measuring-disability-in-a-census.pdf

United States Census Bureau. (2021). Household pulse survey: Measuring social and economic impacts during the coronavirus pandemic. https://www.census.gov/programs-surveys/household-pulse-survey.html

United States Department of Justice. (2014). ADA requirements: Effective communication. https://www.ada.gov/effective-comm.htm

Valdez, R. S., Rogers, C. C., Claypool, H., Trieshmann, L., Frye, O., Wellbeloved-Stone, C., & Kushalnagar, P. (2021). Ensuring full participation of people with disabilities in an era of telehealth. Journal of the American Medical Informatics Association, 28(2), 389-392. https://doi.org/10.1093/jamia/ocaa297

Walter-McCabe, H. A. (2020). Coronavirus health inequities in the United States highlight need for continued community development efforts. The International Journal of Community and Social Development, 2(2), 211-233. https://doi.org/10.1177/2516602620938353

Wolfe, M. K., McDonald, N. C., & Holmes, G. M. (2020). Transportation barriers to health care in the United States: findings from the national health interview survey, 1997–2017. American Journal of Public Health, 110(6), 815-822. https://doi.org/10.2105/AJPH.2020.305579

Young, D., & Edwards, E. (2020). Telehealth and disability: Challenges and opportunities for care. National Health Law Program. https://healthlaw.org/telehealth-and-disability-challenges-and-opportunities-for-care/

Published
2021-12-01
How to Cite
Friedman, C., & VanPuymbrouck, L. (2021). Telehealth Use By Persons with Disabilities During the COVID-19 Pandemic. International Journal of Telerehabilitation, 13(2). https://doi.org/10.5195/ijt.2021.6402
Section
Clinical Practice -COVID 19