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      Addressing Equity in Telemedicine for Chronic Disease Management During the Covid-19 Pandemic

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          Abstract

          The coronavirus crisis exposes disparities in access to care for vulnerable populations, particularly with respect to telemedicine. There is, however, an opportunity, as payers and providers are temporarily embracing expanded use of video visits, to establish practices that will mitigate inequities now and prevent future disruption of chronic disease management.

          Summary

          Health systems have adopted telemedicine with remarkable speed not only for Covid-19–related care, but also for chronic disease management. But without proactive efforts to ensure equity, the current wide-scale implementation of telemedicine may increase disparities in health care access for vulnerable populations with limited digital literacy or access, such as rural residents, racial/ethnic minorities, older adults, and those with low income, limited health literacy, or limited English proficiency. To ensure that the current telemedicine implementation does not exacerbate health disparities, the authors propose four key actions for clinicians and health system leaders: (1) proactively explore potential disparities in telemedicine access, (2) develop solutions to mitigate barriers to digital literacy and the resources needed for engagement in video visits, (3) remove health system–created barriers to accessing video visits, and (4) advocate for policies and infrastructure that facilitate equitable telemedicine access. Without taking these actions now, health care systems risk creating telemedicine programs that exclude vulnerable populations.

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          Most cited references18

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          Combating COVID-19: health equity matters

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            Rapidly Converting to “Virtual Practices”: Outpatient Care in the Era of Covid-19

            Despite ongoing barriers and limitations, patients find relief with virtual care during the Covid-19 pandemic.
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              Usability of Commercially Available Mobile Applications for Diverse Patients.

              Mobile applications or 'apps' intended to help people manage their health and chronic conditions are widespread and gaining in popularity. However, little is known about their acceptability and usability for low-income, racially/ethnically diverse populations who experience a disproportionate burden of chronic disease and its complications.
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                Author and article information

                Contributors
                Journal
                NEJM Catal Innov Care Deliv
                NEJM Catal Innov Care Deliv
                cat-non-issue
                Nejm Catalyst Innovations in Care Delivery
                Massachusetts Medical Society
                2642-0007
                04 May 2020
                : 10.1056/CAT.20.0123
                Affiliations
                [1]Research Fellow, Division of General Internal Medicine, Department of Medicine, University of California San Francisco;
                [2]Assistant Professor, Division of General Internal Medicine, Department of Medicine, University of California San Francisco; Core Faculty, UCSF Center for Vulnerable Populations at Zuckerberg San Francisco General Hospital;
                [3]Associate Professor, Division of General Internal Medicine, Department of Medicine, University of California San Francisco; Core Faculty, UCSF Center for Vulnerable Populations, Zuckerberg San Francisco General Hospital; Associate Professor, Department of Epidemiology and Biostatistics, University of California San Francisco;
                [4]Director, Center for Aging in Diverse Communities (CADC) and Multiethnic Health Equity Research Center (MERC), University of California San Francisco; Professor, Division of General Internal Medicine, University of California San Francisco;
                Author information
                https://orcid.org/0000-0002-2514-3572
                Article
                CAT.20.0123
                10.1056/CAT.20.0123
                7371279
                d1549a5a-601c-4b47-9466-4f02cbe25e7b
                Copyright ©2020 Massachusetts Medical Society.

                This article is made available via the PMC Open Access Subset for unrestricted re-use, except commercial resale, and analyses in any form or by any means with acknowledgment of the original source. These permissions are granted for the duration of the Covid-19 pandemic or until revoked in writing. Upon expiration of these permissions, PMC is granted a license to make this article available via PMC and Europe PMC, subject to existing copyright protections.

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