Background and Aims

Telehealth can bring care into the homes of patients. However, there is a risk that telehealth may worsen health care disparities.

Methods

Prior to the COVID-19 pandemic, patients were only eligible for telehealth if referred by their diabetes provider. Providers assisted patients with device downloads and technical issues. There was no access to interpreters, social workers, or nutritionists.

The COVID-19 pandemic necessitated transition to telehealth in March 2020. Certified diabetes educators helped obtain device downloads, medical assistants provided connection support, and workflows were developed to incorporate interpreters, social workers, and nutritionists into telehealth visits (Fig1).

Chart review was performed for telehealth visits between July 1, 2017 and April 30, 2020. Visits for children with public insurance, a marker of lower socioeconomic status, and those who were non-English speaking were determined.

Results

In the 31 months prior to COVID-19, 195 telehealth visits were performed and in the first 6 weeks of the pandemic, another 436 telehealth visits were completed. In our practice, 38.4% of children have public insurance and 17.4% of the population is non-English speaking. The percentage of children with public insurance who accessed telehealth increased from 24.1% to 39.9% with the new workflow (p=0.004). The percentage of non-English speakers accessing telehealth increased from 3.1% to 13.5% (p<0.01) with the new workflow.

Conclusions

Prior to the COVID-19 pandemic, our workflows were sub-optimal and this increased disparities for children who were non-English speaking or from lower socioeconomic status. The creation of inclusive workflows and support for patients and providers helped close the disparities gap.